Provider Demographics
NPI:1538204342
Name:MILTON, LUTRICIA DAVANNA
Entity type:Individual
Prefix:
First Name:LUTRICIA
Middle Name:DAVANNA
Last Name:MILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 E HACKETT RD # 95358
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358-9001
Mailing Address - Country:US
Mailing Address - Phone:209-525-7218
Mailing Address - Fax:
Practice Address - Street 1:190 E HACKETT RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358-9001
Practice Address - Country:US
Practice Address - Phone:209-525-7218
Practice Address - Fax:209-525-7218
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA8019101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)