Provider Demographics
NPI:1265910780
Name:LUCAS, ANGELA LAWSON (LMBT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LAWSON
Last Name:LUCAS
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 ROCKCLIFF TER
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27205-1532
Mailing Address - Country:US
Mailing Address - Phone:336-964-2800
Mailing Address - Fax:336-629-6939
Practice Address - Street 1:600 W SALISBURY ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5590
Practice Address - Country:US
Practice Address - Phone:336-964-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9093225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty