Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1073004875 |
---|---|
Provider Name | Mr. Carvin Lee Lucas |
First Address | Mount Olive, NC 28365-2124 |
Second Address | Mount Olive, NC 28365-2124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2018 |
Last Update Date | 29/05/2018 |