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General NPI Number Information
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NPI Number | 1053056226
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Entity Type | Organization
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Legal Business Name | LUCID CLINICAL SERVICES LLC
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Dates
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Enumeration Date | 05/03/2022
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Last Update Date | 05/03/2022
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Provider Practice Location Address
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Address Line | 11821 PARKLAWN DR STE 220
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City | ROCKVILLE
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State | MD
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Zip | 20852-2539
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Country | US
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Telephone | 301-453-5162
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Fax |
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Provider Business Mailing Address
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Address Line | 11821 PARKLAWN DR STE 220
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City | ROCKVILLE
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State | MD
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Zip | 20852-2539
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | CRYSTAL SHELTON
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Credential | DR
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Telephone | 203-313-3463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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