Provider Demographics
NPI:1215174891
Name:WHITFIELD, LUTICIA A (LCADC-ADCLAD00224104)
Entity type:Individual
Prefix:MS
First Name:LUTICIA
Middle Name:A
Last Name:WHITFIELD
Suffix:
Gender:F
Credentials:LCADC-ADCLAD00224104
Other - Prefix:
Other - First Name:LUTICIA
Other - Middle Name:A
Other - Last Name:WHITFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCADC-ADCLAD00224104
Mailing Address - Street 1:4609 KIEFER RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216
Mailing Address - Country:US
Mailing Address - Phone:502-417-0961
Mailing Address - Fax:
Practice Address - Street 1:801 W BROADWAY SUITE 4
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-416-8783
Practice Address - Fax:502-305-6578
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYADCLAD00224104101YA0400X
KY1005101YA0400X
KY5787101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100856880Medicaid