Individual
DR. MARY LOUISE LUCKHARDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
4909 WATERS EDGE DRIVE, SUITE 100, RALEIGH, NC 27606
(919) 816-9008
Mailing address
5628 CARY GLEN BLVD., RALEIGH, NC 27519
(919) 467-3343
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
782
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60-00027
—
NC
Enumeration date
05/02/2007
Last updated
07/08/2007
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