Provider Demographics
NPI:1013640531
Name:LACY, SYDNIE ALEXANDRIA
Entity Type:Individual
Prefix:
First Name:SYDNIE
Middle Name:ALEXANDRIA
Last Name:LACY
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 1:6026A MOKAPU CT
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-6006
Mailing Address - Country:US
Mailing Address - Phone:704-798-9368
Mailing Address - Fax:
Practice Address - Street 1:6026A MOKAPU CT
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-6006
Practice Address - Country:US
Practice Address - Phone:704-798-9368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician