Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 0701006317 | VA |
N | 101YS0200X | School Counselor | PPS-0603822 | VA |
NPI | 1174996458 |
---|---|
Provider Name | Randall Lee Lucas |
First Address | Strasburg, VA 22657-2114 |
Second Address | Stephens City, VA 22655-2835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2015 |
Last Update Date | 09/11/2015 |