Provider Demographics
NPI:1619773447
Name:BORDIUK, LUCIA (MED)
Entity type:Individual
Prefix:
First Name:LUCIA
Middle Name:
Last Name:BORDIUK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 GOTHIC CT STE 108
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2812
Mailing Address - Country:US
Mailing Address - Phone:615-492-1132
Mailing Address - Fax:
Practice Address - Street 1:209 GOTHIC CT STE 108
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2812
Practice Address - Country:US
Practice Address - Phone:615-492-1132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6854101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health