Provider Demographics
NPI:1629311907
Name:LUSK, CARRIE F (MA)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:F
Last Name:LUSK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 S MCQUEEN ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4723
Mailing Address - Country:US
Mailing Address - Phone:843-407-4440
Mailing Address - Fax:843-407-4461
Practice Address - Street 1:314 S MCQUEEN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4723
Practice Address - Country:US
Practice Address - Phone:843-407-4440
Practice Address - Fax:843-407-4461
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6099101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional