Provider Demographics
NPI:1689470858
Name:LUCKY, TERRANCE K II (PHD)
Entity type:Individual
Prefix:DR
First Name:TERRANCE
Middle Name:K
Last Name:LUCKY
Suffix:II
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785H KING GEORGE BLVD STE D-1006
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-9551
Mailing Address - Country:US
Mailing Address - Phone:912-658-9125
Mailing Address - Fax:
Practice Address - Street 1:785H KING GEORGE BLVD STE D-1006
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-9551
Practice Address - Country:US
Practice Address - Phone:912-658-9125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty