Healthcare Provider Details

I. General information

NPI: 1922840586
Provider Name (Legal Business Name): RACHEL NICOLE LUKER ALC, M.ED., ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 LOMAC ST
MONTGOMERY AL
36106-2817
US

IV. Provider business mailing address

4171 LOMAC ST STE F
MONTGOMERY AL
36106-2945
US

V. Phone/Fax

Practice location:
  • Phone: 334-221-7979
  • Fax:
Mailing address:
  • Phone: 334-267-7599
  • Fax: 334-845-7002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberALC04916
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: