MEDICARE: A. LUKE LUKENS LCSW CORPORATION

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
1	261QM0850X	Adult Mental Health Clinic/Center	CSW002534	GA

General Provider Information

NPI Number	:	1346598174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A. LUKE LUKENS LCSW CORPORATION

Provider Business Mailing Address
First Line	:	750 LONGLEAF BLVD
Second Line	:	SUITE C
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046
Country	:	US
Telephone Number	:	404-242-4772
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 LONGLEAF BLVD
Second Line	:	SUITE C
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-8459
Country	:	US
Telephone Number	:	404-242-4772
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER PRIVATE PRAC
Name	:	MR. ALLEN D LUKENS
Credential	:	LCSW
Telephone Number	:	404-242-4772

Provider Enumeration Date	:	08/28/2012
Last Update Date	:	08/28/2012

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