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NPI Code Detail

MEDICARE: LUCAS BLAIR LSW, LICDC

MEDICARE: LUCAS BLAIR LSW, LICDC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorLICDC.162201OH
2104100000XSocial WorkerS.1802360OH
31041C0700XClinical Social WorkerI.2304670OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033545520
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUCAS BLAIR LSW, LICDC
Provider Business Mailing Address
First Line : 100 CROWNE POINT PL
Second Line :
City : CINCINNATI
State : OH
Zip : 45241-5427
Country : US
Telephone Number : 513-743-7628
Fax Number : 513-737-1107
Provider Business Practice Location Address
First Line : 36 N DETROIT ST
Second Line :
City : XENIA
State : OH
Zip : 45385-2909
Country : US
Telephone Number : 937-610-4673
Fax Number : 937-736-2615
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2013
Last Update Date : 12/12/2023

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Directions to “ LUCAS BLAIR LSW, LICDC” Practice Location

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