Individual
ILISHA LUCAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CIT, NCAMP, NCIP
Contact information
Practice address
3015 HIGHWAY 956, ETHEL, LA 70730-4520
(225) 681-8414
Mailing address
5820 GLEN OAKS DR, BATON ROUGE, LA 70811-6217
(225) 505-0041
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
4052
LA
Other
Enumeration date
02/04/2019
Last updated
02/04/2019
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