Provider Demographics
NPI:1811208101
Name:MADDREY, LACEY NICOLE (LGSW)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:NICOLE
Last Name:MADDREY
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 CONNECTICUT AVE NW APT 130
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-5100
Mailing Address - Country:US
Mailing Address - Phone:919-408-1525
Mailing Address - Fax:
Practice Address - Street 1:4400 IOWA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5604
Practice Address - Country:US
Practice Address - Phone:202-340-6458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50078831104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker