| NPI | 1376181859 |
|---|---|
| Former Name | LASONJA RENEE LUCKETT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041S0200X Social Worker, School | |
| Enumeration Date | 2019-12-16 |
| Last Update Date | 2019-12-16 |