Provider Demographics
NPI:1902624471
Name:MAGILL, LUCANNE (LPMT, LCAT, MT-BC)
Entity type:Individual
Prefix:
First Name:LUCANNE
Middle Name:
Last Name:MAGILL
Suffix:
Gender:F
Credentials:LPMT, LCAT, MT-BC
Other - Prefix:
Other - First Name:LUCILLE
Other - Middle Name:ANNE
Other - Last Name:MAGILL LEVREAULT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPMT
Mailing Address - Street 1:226 KELLER DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-4170
Mailing Address - Country:US
Mailing Address - Phone:909-229-2757
Mailing Address - Fax:
Practice Address - Street 1:1480 CHAPEL HILL
Practice Address - Street 2:SUITE 220
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502
Practice Address - Country:US
Practice Address - Phone:909-229-2757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00531225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist