Individual
LUCIOUS CONWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 W 122ND ST, 504, NEW YORK, NY 10027-5410
(718) 514-4560
Mailing address
201 W 122ND ST, 504, NEW YORK, NY 10027-5410
(718) 514-4560
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CARC-90
NY
101YP1600X
Pastoral Counselor
200924
OK
Other
Enumeration date
05/30/2013
Last updated
10/16/2013
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