Healthcare Provider Details

I. General information

NPI: 1285590455
Provider Name (Legal Business Name): IRINA CATALINA LUCA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3883 BAXLEY PINE TRL
SUWANEE GA
30024-8449
US

IV. Provider business mailing address

3883 BAXLEY PINE TRL
SUWANEE GA
30024-8449
US

V. Phone/Fax

Practice location:
  • Phone: 404-729-2740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW009283
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: