Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor |
NPI | 1003232471 |
---|---|
Provider Name | Carlos Lucas |
First Address | Sacramento, CA 95820-1093 |
Second Address | Sacramento, CA 95820-1093 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2014 |
Last Update Date | 24/09/2019 |