Provider Demographics
NPI:1821343302
Name:LUCAS, GEORGE (CSAC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:LUCAS
Suffix:
Gender:M
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 WAIMANU ST STE 614
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5267
Mailing Address - Country:US
Mailing Address - Phone:808-533-3936
Mailing Address - Fax:808-791-6198
Practice Address - Street 1:875 WAIMANU ST STE 614
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5267
Practice Address - Country:US
Practice Address - Phone:808-533-3936
Practice Address - Fax:808-791-6198
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1479-09101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)