Provider Demographics
NPI:1821857467
Name:LUCAS, KANDISE (BA, MSED, PHD)
Entity Type:Individual
Prefix:DR
First Name:KANDISE
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:BA, MSED, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10905 SASSAFRAS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23860-7606
Mailing Address - Country:US
Mailing Address - Phone:804-248-8656
Mailing Address - Fax:
Practice Address - Street 1:10906 SASSAFRAS DR
Practice Address - Street 2:
Practice Address - City:NORTH PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23860-7607
Practice Address - Country:US
Practice Address - Phone:804-248-8656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No171400000XOther Service ProvidersHealth & Wellness Coach
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No372500000XNursing Service Related ProvidersChore Provider
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child