=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689536450
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IMPACTWORKS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2025
-----------------------------------------------------
Last Update Date | 12/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 907 CALVIN TER
-----------------------------------------------------
City | NORTH AUGUSTA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 839-273-0143
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 907 CALVIN TER
-----------------------------------------------------
City | NORTH AUGUSTA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29841-2379
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 839-273-0143
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST/CONSULTANT
-----------------------------------------------------
Name | LUCAS ANTHONY DEMONTE
-----------------------------------------------------
Credential | LMHC, LPC, NCC
-----------------------------------------------------
Telephone | 839-273-0143
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------