Individual
MS. TIA NICOLE LUCAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
209 NE MAIN ST, ROCKY MOUNT, NC 27801-5301
(252) 497-3661
Mailing address
209 NE MAIN ST, ROCKY MOUNT, NC 27801-5301
(252) 497-3661
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
11/13/2017
Last updated
11/13/2017
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