Healthcare Provider Details

I. General information

NPI: 1124584354
Provider Name (Legal Business Name): DAWN LEE LUCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 N M 52
OWOSSO MI
48867-1290
US

IV. Provider business mailing address

1480 N M 52
OWOSSO MI
48867-1290
US

V. Phone/Fax

Practice location:
  • Phone: 989-723-8239
  • Fax: 989-723-8230
Mailing address:
  • Phone: 989-723-8239
  • Fax: 989-723-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: