Provider Demographics
NPI:1225356207
Name:LARA, MARCIA LYNNE (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:LYNNE
Last Name:LARA
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 1:1075 LONESOME PINE RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37082-5210
Mailing Address - Country:US
Mailing Address - Phone:615-579-8124
Mailing Address - Fax:
Practice Address - Street 1:810 DOMINICAN DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1906
Practice Address - Country:US
Practice Address - Phone:615-579-8124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2016-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000002316101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional