Provider Demographics
NPI:1629696927
Name:LUKOW, ALEXANDRA JACQUELINE (BS)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:JACQUELINE
Last Name:LUKOW
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:JACQUELINE
Other - Last Name:LUKOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9305 MONROE RD STE L
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-1490
Mailing Address - Country:US
Mailing Address - Phone:980-819-0010
Mailing Address - Fax:
Practice Address - Street 1:9305 MONROE RD STE L
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-1490
Practice Address - Country:US
Practice Address - Phone:980-819-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZCF931976211225OtherBLUECROSS