Provider Demographics
NPI:1447010392
Name:MASON-UNDERDUE, LUCRETIA (LPC)
Entity type:Individual
Prefix:
First Name:LUCRETIA
Middle Name:
Last Name:MASON-UNDERDUE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:LUCRETIA
Other - Middle Name:
Other - Last Name:MASON-UNDERDUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, MED
Mailing Address - Street 1:5602 PARISH LN
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-1539
Mailing Address - Country:US
Mailing Address - Phone:757-641-8589
Mailing Address - Fax:757-484-4026
Practice Address - Street 1:5602 PARISH LN
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-1539
Practice Address - Country:US
Practice Address - Phone:757-641-8589
Practice Address - Fax:757-484-4026
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013136101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional