Provider Demographics
NPI:1932333127
Name:LUCENT COLLABORATIVE SERVICES, INC
Entity Type:Organization
Organization Name:LUCENT COLLABORATIVE SERVICES, INC
Other - Org Name:LUCENT COLLABORATIVE SERVICES, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICE-DIANE
Authorized Official - Middle Name:DEE DEE
Authorized Official - Last Name:SCHARF
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LHMC,
Authorized Official - Phone:352-332-6131
Mailing Address - Street 1:4703 NW 53RD AVENUE
Mailing Address - Street 2:SUITE A2
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653
Mailing Address - Country:US
Mailing Address - Phone:352-332-6131
Mailing Address - Fax:352-332-6263
Practice Address - Street 1:4703 NW 53RD AVENUE
Practice Address - Street 2:SUITE A2
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653
Practice Address - Country:US
Practice Address - Phone:352-332-6131
Practice Address - Fax:352-332-6263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-04
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5243101YM0800X, 101YP2500X
101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty