Provider Demographics
NPI:1134845068
Name:LUCAS, DAVID (CSC-AD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LUCAS
Suffix:
Gender:M
Credentials:CSC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT DEPOSIT
Mailing Address - State:MD
Mailing Address - Zip Code:21904-1211
Mailing Address - Country:US
Mailing Address - Phone:667-298-5367
Mailing Address - Fax:
Practice Address - Street 1:111 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5996
Practice Address - Country:US
Practice Address - Phone:443-406-3234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC2937101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)