Healthcare Provider Details

I. General information

NPI: 1568503308
Provider Name (Legal Business Name): DEBORAH ANN LUCAS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 LIBERTY ST
CLARION PA
16214-1829
US

IV. Provider business mailing address

3822 SHANNONDALE RD
MAYPORT PA
16240-3328
US

V. Phone/Fax

Practice location:
  • Phone: 814-226-8669
  • Fax: 814-226-5329
Mailing address:
  • Phone: 814-379-3304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC004153
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: