| NPI | 1518492784 |
|---|---|
| Former Name | KYLE ANN LUCAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT 37585) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT LAC-LIC-3436) |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2019-04-19 |