Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YS0200X | School Counselor |
NPI | 1114207578 |
---|---|
Provider Name | Carly Lukas |
First Address | Oakland, CA 94608-2708 |
Second Address | El Cerrito, CA 94530-2157 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2011 |
Last Update Date | 31/05/2021 |