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General NPI Number Information
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NPI Number | 1689040032
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Entity Type | Individual
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Provider Name | ROCKY LUCAS LICSW, MSW
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Gender | Male
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 4602 MACCORKLE AVE SE
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City | CHARLESTON
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State | WV
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Zip | 25304-1848
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Country | US
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Telephone | 304-205-7535
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Fax | 304-205-7536
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Provider Business Mailing Address
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Address Line | 104 ALEX LN
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City | CHARLESTON
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State | WV
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Zip | 25304-2952
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Country | US
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Telephone | 304-734-2040
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Fax | 304-734-2047
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | DP00944158
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License Number State | WV
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