Provider Demographics
NPI:1649810243
Name:LUCAS, LAKRESHA ANTOINETTE
Entity type:Individual
Prefix:
First Name:LAKRESHA
Middle Name:ANTOINETTE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 RANCH RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-8136
Mailing Address - Country:US
Mailing Address - Phone:248-818-3086
Mailing Address - Fax:
Practice Address - Street 1:4001 RANCH RD
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-8136
Practice Address - Country:US
Practice Address - Phone:248-818-3086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MD106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician