Trisstan Ja'Von Luckett, NCC, LPCA

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

A12893 Issued in NC

Practice address

650 Highland Ave
Winston Salem, NC 27101-4304

Phone

(336) 607-8523

Fax

(336) 773-0916

NPI assigned

Sep 25, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1537833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537833600000",
    "number": "1326522434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "284 EXECUTIVE PARK DR STE 100",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280251833",
            "telephone_number": "704-939-1100",
            "fax_number": "704-939-1173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 HIGHLAND AVE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271014304",
            "telephone_number": "336-607-8523",
            "fax_number": "336-773-0916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCKETT",
        "first_name": "TRISSTAN",
        "middle_name": "JA'VON",
        "credential": "NCC, LPCA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-25",
        "last_updated": "2018-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "A12893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Paul Lucas
• Michael Hautea Lucero, P.T.
• George William Lucia Jr., D.C.
• Jennifer Michelle Lucio, NP
• Tomas Matias Lucioni, MD
• Adam Luckey, M.D.
• Lucky Little Voices
• Russell Nathan Ludwig Worthen, NP-C
• Andrea Colby Luebchow, PHARMD
• Francis Cheuk Yin Luk, M.D.

• Professional Counselor in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.