Provider Demographics
NPI:1750075230
Name:LUCAS, DEVIN DAVID (MA, LLC)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:DAVID
Last Name:LUCAS
Suffix:
Gender:M
Credentials:MA, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 TRINWAY DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-3184
Mailing Address - Country:US
Mailing Address - Phone:248-930-9934
Mailing Address - Fax:
Practice Address - Street 1:3121 UNIVERSITY DR STE 120
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-4606
Practice Address - Country:US
Practice Address - Phone:248-564-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023047101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health