Healthcare Provider Details

I. General information

NPI: 1164820395
Provider Name (Legal Business Name): LUCERO MORSE APC, NCC, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2014
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 W PEACHTREE ST NE
ATLANTA GA
30309-3608
US

IV. Provider business mailing address

620 PEACHTREE ST NE APT 1112
ATLANTA GA
30308-2371
US

V. Phone/Fax

Practice location:
  • Phone: 404-589-9040
  • Fax:
Mailing address:
  • Phone: 678-439-5823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC004551
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: