Healthcare Provider Details

I. General information

NPI: 1114787058
Provider Name (Legal Business Name): LAKELYN JUNE LUKE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 01/19/2026
Certification Date: 01/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10164 FORD AVE
RICHMOND HILL GA
31324-3949
US

IV. Provider business mailing address

10164 FORD AVE STE D
RICHMOND HILL GA
31324-3948
US

V. Phone/Fax

Practice location:
  • Phone: 912-459-9999
  • Fax:
Mailing address:
  • Phone: 912-617-7226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-87163
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number16549
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: