Individual
JESSE MICHAEL LUCABAUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2601 WILLARD RD STE 105, RICHMOND, VA 23294-3638
(046) 661-8799
Mailing address
1519 AVONDALE AVE, RICHMOND, VA 23227-4027
(804) 661-8799
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0133002336
VA
Other
Enumeration date
03/10/2022
Last updated
03/10/2022
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