Provider Demographics
NPI:1922758051
Name:WASHINGTON, LUCAS ALCANTARA (RBT, CTRS)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:ALCANTARA
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:RBT, CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402B LEGACY PARK
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4315
Mailing Address - Country:US
Mailing Address - Phone:769-233-7154
Mailing Address - Fax:
Practice Address - Street 1:402B LEGACY PARK
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4315
Practice Address - Country:US
Practice Address - Phone:769-233-7154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS64000225800000X
MSRBT-19-89653106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist