Provider Demographics
NPI:1306399035
Name:HARE, LACY ANN (CSC-AD)
Entity Type:Individual
Prefix:
First Name:LACY
Middle Name:ANN
Last Name:HARE
Suffix:
Gender:F
Credentials:CSC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 ROWE BLVD
Mailing Address - Street 2:ROOM 224
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1539
Mailing Address - Country:US
Mailing Address - Phone:410-260-1976
Mailing Address - Fax:410-260-1979
Practice Address - Street 1:251 ROWE BLVD
Practice Address - Street 2:ROOM 224
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1539
Practice Address - Country:US
Practice Address - Phone:410-260-1976
Practice Address - Fax:410-260-1979
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1014A00X101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)