Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 20858 | NC |
Y | 101YM0800X | Mental Health Counselor | 11087 | NC |
N | 101YP2500X | Professional Counselor | 11087 | NC |
N | 225C00000X | Rehabilitation Counselor | 00118288 |
NPI | 1003221318 |
---|---|
Provider Name | Shannell Lucas |
First Address | Greensboro, NC 27455-2776 |
Second Address | Greensboro, NC 27455-2776 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2014 |
Last Update Date | 16/02/2021 |