Provider Demographics
NPI:1730492596
Name:LACY, CHRISTINA ROSE (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ROSE
Last Name:LACY
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 1:1561 HAWTHORNE LN
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-7344
Mailing Address - Country:US
Mailing Address - Phone:334-590-1580
Mailing Address - Fax:
Practice Address - Street 1:1561 HAWTHORNE LN
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7344
Practice Address - Country:US
Practice Address - Phone:334-590-1580
Practice Address - Fax:334-590-1580
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2854101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional