Provider Information for 1528205614
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LASHAWN BLACKMON LUCAS LMFT
Sex: Female
NPI: 1528205614
Last Updated: 2024-08-04
Certification Date: 2024-08-04
Certification Date: 2024-08-04
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1528205614 | ||||||||
| Enumeration Date | 2009-01-12 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 900 E GILBERT ST SAN BERNARDINO, CA 92415-1003 United States Phone: 909-386-0704 | Fax: | ||||||||
| Primary Practice Address | 900 E GILBERT ST SAN BERNARDINO, CA 92415-0911 United States Phone: 909-386-0704 | Fax: | ||||||||
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