Provider Demographics
NPI:1104124288
Name:LUCKING, VICTORIA F (LCSW)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:F
Last Name:LUCKING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4612 GROUNDNUT CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-4138
Mailing Address - Country:US
Mailing Address - Phone:919-740-9821
Mailing Address - Fax:919-510-6090
Practice Address - Street 1:109 E OAK ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:NC
Practice Address - Zip Code:27576-2845
Practice Address - Country:US
Practice Address - Phone:919-502-9361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOO37631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007429Medicaid
NC1700064375OtherNPI PROFESSIONAL LIMITED LIABILITY CORPORATION