Provider Demographics
NPI:1992461453
Name:LUCAS, LORRAINE DESIREA
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:DESIREA
Last Name:LUCAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 TERRITORIAL RD W
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-3240
Mailing Address - Country:US
Mailing Address - Phone:126-935-8909
Mailing Address - Fax:
Practice Address - Street 1:68 TERRITORIAL RD W
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-3240
Practice Address - Country:US
Practice Address - Phone:126-385-8909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health