Provider Demographics
NPI:1801033980
Name:MCMICHAEL, LUCILLE LEE (LCSW)
Entity type:Individual
Prefix:MS
First Name:LUCILLE
Middle Name:LEE
Last Name:MCMICHAEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1830 DESTINY LN
Mailing Address - Street 2:SUITE 112
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-1087
Mailing Address - Country:US
Mailing Address - Phone:270-779-7312
Mailing Address - Fax:270-393-9011
Practice Address - Street 1:1830 DESTINY LN 112
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-1089
Practice Address - Country:US
Practice Address - Phone:270-746-9995
Practice Address - Fax:270-393-9001
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical