Provider Demographics
NPI:1568874808
Name:HERRINGTON, LACEY LOY (PHD)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:LOY
Last Name:HERRINGTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LINCOLN PKWY
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-3262
Mailing Address - Country:US
Mailing Address - Phone:601-288-8050
Mailing Address - Fax:601-288-8058
Practice Address - Street 1:1 LINCOLN PKWY
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3262
Practice Address - Country:US
Practice Address - Phone:601-288-8050
Practice Address - Fax:601-288-8058
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS802301037390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program