=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760691786
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA LYN LUCAS LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2922 W MARSHALL ST
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23230-4811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-233-2850
-----------------------------------------------------
Fax | 804-233-3443
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8393 BRITTEWOOD CIR
-----------------------------------------------------
City | MECHANICSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23116-2926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-233-2850
-----------------------------------------------------
Fax | 804-233-3443
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0904004467
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------