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General NPI Number Information
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NPI Number | 1821857467
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Entity Type | Individual
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Provider Name | KANDISE LUCAS B.A, MSED, PHD
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Gender | Female
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Dates
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Enumeration Date | 03/18/2024
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 10906 SASSAFRAS DR
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City | NORTH PRINCE GEORGE
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State | VA
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Zip | 23860-7607
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Country | US
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Telephone | 804-248-8656
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Fax |
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Provider Business Mailing Address
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Address Line | 10905 SASSAFRAS DR
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City | NORTH PRINCE GEORGE
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State | VA
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Zip | 23860-7606
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Country | US
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Telephone | 804-248-8656
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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 | 146D00000X
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Taxonomy Name | Personal Emergency Response Attendant
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License Number |
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Taxonomy #2
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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Taxonomy #4
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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Taxonomy #5
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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Taxonomy #6
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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Taxonomy #7
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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Taxonomy #8
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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