Provider Demographics
NPI:1902180102
Name:HENDRICKSON, LUCAS GERARD (CAADC, MFT-I)
Entity Type:Individual
Prefix:MR
First Name:LUCAS
Middle Name:GERARD
Last Name:HENDRICKSON
Suffix:
Gender:M
Credentials:CAADC, MFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WILLOW GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3319
Mailing Address - Country:US
Mailing Address - Phone:510-926-9596
Mailing Address - Fax:
Practice Address - Street 1:16 WILLOW GLEN AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3319
Practice Address - Country:US
Practice Address - Phone:510-926-9596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82591106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist