Provider Demographics
NPI:1790436566
Name:LUCAS, GEORGE W
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:W
Last Name:LUCAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 ELKRIDGE LANDING RD STE 350
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2909
Mailing Address - Country:US
Mailing Address - Phone:443-354-8903
Mailing Address - Fax:443-410-0643
Practice Address - Street 1:939 ELKRIDGE LANDING RD STE 350
Practice Address - Street 2:
Practice Address - City:LINTHICUM
Practice Address - State:MD
Practice Address - Zip Code:21090-2909
Practice Address - Country:US
Practice Address - Phone:443-354-8903
Practice Address - Fax:443-410-0643
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MD29623104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program