Provider Demographics
NPI:1265017198
Name:MAHAN, LUCRETIA (ASW)
Entity type:Individual
Prefix:
First Name:LUCRETIA
Middle Name:
Last Name:MAHAN
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:LUCRETIA
Other - Middle Name:
Other - Last Name:DENDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1864 HABERDASHER PL
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-6383
Mailing Address - Country:US
Mailing Address - Phone:619-549-6150
Mailing Address - Fax:
Practice Address - Street 1:1120 LASKIN RD STE 104
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-5273
Practice Address - Country:US
Practice Address - Phone:757-650-5346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9633831041C0700X, 1041C0700X
VA09040169051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical