Provider Demographics
NPI:1437163870
Name:LACEY, SHELAGH MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHELAGH
Middle Name:MARIE
Last Name:LACEY
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 1:3701 5TH ST S
Mailing Address - Street 2:#107
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1641
Mailing Address - Country:US
Mailing Address - Phone:703-207-7792
Mailing Address - Fax:703-289-2764
Practice Address - Street 1:3701 5TH ST S
Practice Address - Street 2:#107
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1641
Practice Address - Country:US
Practice Address - Phone:703-207-7792
Practice Address - Fax:703-289-2764
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904003747101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904003747OtherL.C;S.W.LICENSE