Provider Demographics
NPI:1891820072
Name:LUCAS, PEGGY L (LPCC, LICDC)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:L
Last Name:LUCAS
Suffix:
Gender:F
Credentials:LPCC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-1736
Mailing Address - Country:US
Mailing Address - Phone:740-914-5000
Mailing Address - Fax:740-914-5005
Practice Address - Street 1:827 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-1736
Practice Address - Country:US
Practice Address - Phone:740-914-5000
Practice Address - Fax:740-914-5005
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH965798101YA0400X
OH175T00000X
OHE.0002560101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist