Provider Demographics
NPI:1629773924
Name:LUCIANO, DEANA MARIE (LCMHCA, LCAS)
Entity type:Individual
Prefix:
First Name:DEANA
Middle Name:MARIE
Last Name:LUCIANO
Suffix:
Gender:F
Credentials:LCMHCA, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 EMORY RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-2003
Mailing Address - Country:US
Mailing Address - Phone:954-496-4557
Mailing Address - Fax:
Practice Address - Street 1:6124 SAINT GILES ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-7042
Practice Address - Country:US
Practice Address - Phone:919-893-4465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18574101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health