Healthcare Provider Details

I. General information

NPI: 1619784964
Provider Name (Legal Business Name): LAWDY LUCTAMA RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 BRAMBLETON AVE STE 201A
ROANOKE VA
24018-6527
US

IV. Provider business mailing address

3433 BRAMBLETON AVE STE 201A
ROANOKE VA
24018-6527
US

V. Phone/Fax

Practice location:
  • Phone: 844-822-2250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: