Provider Demographics
NPI:1699855197
Name:LUCAS, SHARON (LCSW)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:LUCAS
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 1:3611 CHAIN BRIDGE RD STE D
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3246
Mailing Address - Country:US
Mailing Address - Phone:703-865-8880
Mailing Address - Fax:703-865-8891
Practice Address - Street 1:3611 CHAIN BRIDGE RD STE D
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3246
Practice Address - Country:US
Practice Address - Phone:703-865-8880
Practice Address - Fax:703-865-8891
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040062051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA354934OtherANTHEM BLUE CROSS AND BLUE SHIELD
VA1699855197Medicaid