Provider Demographics
NPI:1134736325
Name:DURIAS, LUCRETIA (LPCA, TCADC)
Entity type:Individual
Prefix:
First Name:LUCRETIA
Middle Name:
Last Name:DURIAS
Suffix:
Gender:F
Credentials:LPCA, TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 W BROADWAY STE 1D
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211-1475
Mailing Address - Country:US
Mailing Address - Phone:502-384-7115
Mailing Address - Fax:502-709-5435
Practice Address - Street 1:3050 W BROADWAY STE 1D
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-1475
Practice Address - Country:US
Practice Address - Phone:502-384-7115
Practice Address - Fax:502-709-5435
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
KY171M00000X
KY282344101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator