Provider Demographics
NPI:1114582517
Name:JACOBS, LACEE OVERCASH (LPCA)
Entity Type:Individual
Prefix:
First Name:LACEE
Middle Name:OVERCASH
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:LACEE
Other - Middle Name:ANNE
Other - Last Name:OVERCASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1045 LAKE WRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:CHINA GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28023-7812
Mailing Address - Country:US
Mailing Address - Phone:704-202-4157
Mailing Address - Fax:
Practice Address - Street 1:170 DAVIDSON HWY STE 201
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-4255
Practice Address - Country:US
Practice Address - Phone:704-298-4206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13687101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional