Provider Demographics
NPI:1578371969
Name:LUCAS, ALEXIS MARIAH
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARIAH
Last Name:LUCAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 DIANE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH VERSAILLES
Mailing Address - State:PA
Mailing Address - Zip Code:15137-2435
Mailing Address - Country:US
Mailing Address - Phone:724-978-1189
Mailing Address - Fax:
Practice Address - Street 1:984 DIANE DR
Practice Address - Street 2:
Practice Address - City:NORTH VERSAILLES
Practice Address - State:PA
Practice Address - Zip Code:15137-2435
Practice Address - Country:US
Practice Address - Phone:724-978-1189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health