Provider Demographics
NPI:1801186697
Name:MASON, LUCIELLE LYNN (LPC)
Entity type:Individual
Prefix:
First Name:LUCIELLE
Middle Name:LYNN
Last Name:MASON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LUCY
Other - Middle Name:LYNN
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:723 HI HOPE RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-4541
Mailing Address - Country:US
Mailing Address - Phone:770-277-4494
Mailing Address - Fax:770-338-4177
Practice Address - Street 1:723 HI HOPE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-4541
Practice Address - Country:US
Practice Address - Phone:770-277-4494
Practice Address - Fax:770-338-4177
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006640101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional