Provider Demographics
NPI:1619037645
Name:LACY, BERTILDA DUHON (LCSW)
Entity Type:Individual
Prefix:
First Name:BERTILDA
Middle Name:DUHON
Last Name:LACY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BERTILDA
Other - Middle Name:SHEOLE
Other - Last Name:DUHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:9720 BROADWAY ST APT 1416
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8491
Mailing Address - Country:US
Mailing Address - Phone:832-244-4383
Mailing Address - Fax:
Practice Address - Street 1:11200 BROADWAY ST STE 2743
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-9787
Practice Address - Country:US
Practice Address - Phone:281-937-4139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker