Provider Demographics
NPI:1417720459
Name:LACEY, ANITA MICHELL (LPC)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:MICHELL
Last Name:LACEY
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 1:7213 S ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60455-1043
Mailing Address - Country:US
Mailing Address - Phone:773-558-2780
Mailing Address - Fax:
Practice Address - Street 1:900 RAVINIA PL
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4604
Practice Address - Country:US
Practice Address - Phone:708-422-2898
Practice Address - Fax:815-524-3566
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor