Provider Demographics
NPI:1265503452
Name:DAVID, LUCINDA ANN (MSW)
Entity type:Individual
Prefix:
First Name:LUCINDA
Middle Name:ANN
Last Name:DAVID
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 320
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47448-0320
Mailing Address - Country:US
Mailing Address - Phone:812-669-2080
Mailing Address - Fax:812-372-3692
Practice Address - Street 1:2530 SANDCREST BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3047
Practice Address - Country:US
Practice Address - Phone:812-660-2080
Practice Address - Fax:812-372-3692
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN340036481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100052790AMedicaid
IN144010FMedicare PIN