Provider Demographics
NPI:1821737297
Name:LUCAS, ABIGAEL GORDON (PHD)
Entity type:Individual
Prefix:DR
First Name:ABIGAEL
Middle Name:GORDON
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6560
Mailing Address - Country:US
Mailing Address - Phone:734-273-9181
Mailing Address - Fax:
Practice Address - Street 1:2610 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6560
Practice Address - Country:US
Practice Address - Phone:734-273-9181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6352000457390200000X
MI6351004827103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program