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General NPI Number Information
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NPI Number | 1255732798
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Entity Type | Individual
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Provider Name | MARY VIRGINIA GIRARDEAU LUCAS APRN, FNP-C, PMHNP
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Gender | Female
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Dates
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Enumeration Date | 09/15/2014
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 401 WITSELL ST
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City | WALTERBORO
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State | SC
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Zip | 29488-3052
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Country | US
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Telephone | 843-549-5546
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Fax |
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Provider Business Mailing Address
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Address Line | 2030 POWERS FERRY RD SE SUITE 120
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City | ATLANTA
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State | GA
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Zip | 30339-2823
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Country | US
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Telephone | 678-801-2313
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Fax | 844-249-2637
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 19050
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 19050
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License Number State | SC
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