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General NPI Number Information
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NPI Number | 1346492584
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Entity Type | Individual
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Provider Name | ELIZABETH LUCKRAFT LCPC-C
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Gender | Female
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 09/08/2010
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Provider Practice Location Address
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Address Line | 316 WATER ST
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City | SKOWHEGAN
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State | ME
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Zip | 04976-1734
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Country | US
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Telephone | 207-692-4590
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Fax | 207-634-5142
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Provider Business Mailing Address
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Address Line | 920 E POND RD
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City | SMITHFIELD
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State | ME
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Zip | 04978-3219
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Country | US
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Telephone | 207-692-4590
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Fax | 207-634-5142
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | XL3456
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License Number State | ME
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