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General NPI Number Information
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NPI Number | 1649141417
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Entity Type | Individual
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Provider Name | KELLY C LUCAS APCC
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Gender | Male
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Dates
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Enumeration Date | 09/15/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 9845 ERMA RD STE 200
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City | SAN DIEGO
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State | CA
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Zip | 92131-1057
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Country | US
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Telephone | 619-937-2055
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Fax |
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Provider Business Mailing Address
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Address Line | 3561 ROCK RIDGE RD
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City | CARLSBAD
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State | CA
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Zip | 92010-7089
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Country | US
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Telephone | 500-442-7221
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Fax |
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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 | 15488
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License Number State | CA
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