Healthcare Provider Details

I. General information

NPI: 1508090739
Provider Name (Legal Business Name): LUCAS VRBSKY MSW, LCSW, LCAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2009
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 BRENNER AVE 11M
SALISBURY NC
28144-2515
US

IV. Provider business mailing address

1601 BRENNER AVE 122
SALISBURY NC
28144-2515
US

V. Phone/Fax

Practice location:
  • Phone: 800-469-8262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS3378
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC007433
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: