Provider Demographics
NPI:1861944902
Name:LUCKETT, WILLIAM PETER (LPC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PETER
Last Name:LUCKETT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-4859
Mailing Address - Country:US
Mailing Address - Phone:434-207-8429
Mailing Address - Fax:
Practice Address - Street 1:401 ORANGE ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-4859
Practice Address - Country:US
Practice Address - Phone:434-207-8429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008896101YM0800X, 101YP2500X
NCA12598101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health