Provider Demographics
NPI:1225363161
Name:MOORE, LACEY DEANN (LPC)
Entity Type:Individual
Prefix:MS
First Name:LACEY
Middle Name:DEANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:LACEY
Other - Middle Name:MOORE
Other - Last Name:BROADUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6576 AIRPORT BLVD
Mailing Address - Street 2:SUITE C200
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608
Mailing Address - Country:US
Mailing Address - Phone:251-459-0200
Mailing Address - Fax:251-625-6428
Practice Address - Street 1:6576 AIRPORT BLVD
Practice Address - Street 2:SUITE C200
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608
Practice Address - Country:US
Practice Address - Phone:251-459-0200
Practice Address - Fax:251-625-6428
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2742101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional