Provider Demographics
NPI:1174644124
Name:LACY, CONSTANCE LORAINE (PHD LCSW)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:LORAINE
Last Name:LACY
Suffix:
Gender:F
Credentials:PHD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10006 RIVER BEND DR STE 104
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-8521
Mailing Address - Country:US
Mailing Address - Phone:469-733-5047
Mailing Address - Fax:972-412-5219
Practice Address - Street 1:10006 RIVER BEND DR STE 104
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-8521
Practice Address - Country:US
Practice Address - Phone:469-733-5047
Practice Address - Fax:972-412-5219
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2023-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS351851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX593810OtherBLUE CROSS BLUE SHIELD TEXAS
TX7511715OtherAETNA
TX601292907OtherMAGELLAN HEALTHCARE
TX2559683OtherCIGNA BEHAVIORAL