Provider Demographics
NPI:1770144487
Name:LUCAS, GRACE CARRIE (LCMHC)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:CARRIE
Last Name:LUCAS
Suffix:
Gender:
Credentials:LCMHC
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:CARRIE
Other - Last Name:TOMALAVAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMHC
Mailing Address - Street 1:2325 LAWRENCE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-2626
Mailing Address - Country:US
Mailing Address - Phone:919-740-3099
Mailing Address - Fax:
Practice Address - Street 1:113 EDINBURGH SOUTH DR STE 130
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6456
Practice Address - Country:US
Practice Address - Phone:919-230-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14434101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health