Provider Demographics
NPI:1851453930
Name:LUCKER, DONNA MARIE (LCPC, LCADC)
Entity Type:Individual
Prefix:MISS
First Name:DONNA
Middle Name:MARIE
Last Name:LUCKER
Suffix:
Gender:F
Credentials:LCPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 N POINT BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-3420
Mailing Address - Country:US
Mailing Address - Phone:410-284-3070
Mailing Address - Fax:410-285-3848
Practice Address - Street 1:1107 N POINT BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-3420
Practice Address - Country:US
Practice Address - Phone:410-284-3070
Practice Address - Fax:410-285-3848
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101Y00000X, 101YP1600X
MDLCA335101YA0400X
MDLC1495101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD114351Medicaid