Provider Demographics
NPI:1275027948
Name:COTTINGHAM, LACEY ALLENE (LCSW)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:ALLENE
Last Name:COTTINGHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 PEMBERTON HILL RD STE 202
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4266
Mailing Address - Country:US
Mailing Address - Phone:919-247-8478
Mailing Address - Fax:
Practice Address - Street 1:1011 PEMBERTON HILL RD STE 202
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4266
Practice Address - Country:US
Practice Address - Phone:919-247-8478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0126161041C0700X
NCC0146891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical