Provider Demographics
NPI:1801810056
Name:LUCAS, RHONDA SHERISE (LMSW, ACSW)
Entity type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:SHERISE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 JOHN R.
Mailing Address - Street 2:824
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-671-3912
Mailing Address - Fax:313-861-2390
Practice Address - Street 1:4160 JOHN R ST
Practice Address - Street 2:824
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2020
Practice Address - Country:US
Practice Address - Phone:313-671-3912
Practice Address - Fax:313-861-2390
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010800441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN988-70001Medicare ID - Type Unspecified