Provider Demographics
NPI:1215174891
Name:WHITFIELD, LUTICIA A (LCADC, CSW)
Entity type:Individual
Prefix:MS
First Name:LUTICIA
Middle Name:A
Last Name:WHITFIELD
Suffix:
Gender:F
Credentials:LCADC, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4609 KIEFER RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216
Mailing Address - Country:US
Mailing Address - Phone:502-417-0961
Mailing Address - Fax:
Practice Address - Street 1:801 W BROADWAY SUITE 4
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-416-8783
Practice Address - Fax:502-305-6578
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-19
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
KY101YA0400X
KYADCLAD00224104101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100856880Medicaid
KY7100638500Medicaid