Provider Demographics
NPI:1114419579
Name:HOLOVACKO, LACEY JAYNE (LPC)
Entity Type:Individual
Prefix:MISS
First Name:LACEY
Middle Name:JAYNE
Last Name:HOLOVACKO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 VINEYARD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2515
Mailing Address - Country:US
Mailing Address - Phone:732-331-5507
Mailing Address - Fax:
Practice Address - Street 1:35 BEAVERSON BLVD STE 4D
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7857
Practice Address - Country:US
Practice Address - Phone:908-373-1059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00414900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health