Healthcare Provider Details

I. General information

NPI: 1386574853
Provider Name (Legal Business Name): LUCERNA COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 FORREST RIDGE DR NW
CONCORD NC
28027-8181
US

IV. Provider business mailing address

1131 FORREST RIDGE DR NW
CONCORD NC
28027-8181
US

V. Phone/Fax

Practice location:
  • Phone: 704-957-9788
  • Fax:
Mailing address:
  • Phone: 704-957-9788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. PENELOPE CHIROLDE
Title or Position: MANAGING MEMBER
Credential:
Phone: 704-957-9788