Provider Demographics
NPI:1619552072
Name:LUCAS, SHAKENDRA (LMHC)
Entity type:Individual
Prefix:
First Name:SHAKENDRA
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 ARLINGTON EXPY STE B105
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-0810
Mailing Address - Country:US
Mailing Address - Phone:904-413-8726
Mailing Address - Fax:904-506-7807
Practice Address - Street 1:6501 ARLINGTON EXPRESSWAY B105 #2155
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211
Practice Address - Country:US
Practice Address - Phone:904-413-8726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX97134101YP2500X
FLMH20236101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional