Provider Demographics
NPI:1114787058
Name:LUKE, LAKELYN JUNE (QASP-S)
Entity type:Individual
Prefix:
First Name:LAKELYN
Middle Name:JUNE
Last Name:LUKE
Suffix:
Gender:
Credentials:QASP-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 FAIRBURN CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:GA
Mailing Address - Zip Code:31302-9715
Mailing Address - Country:US
Mailing Address - Phone:912-617-7226
Mailing Address - Fax:
Practice Address - Street 1:10164 FORD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3949
Practice Address - Country:US
Practice Address - Phone:912-459-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
GA16549106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician