Provider Demographics
NPI:1891562930
Name:WEST, LACY MCKAY ADAMSON (APC ATR)
Entity Type:Individual
Prefix:
First Name:LACY MCKAY
Middle Name:ADAMSON
Last Name:WEST
Suffix:
Gender:F
Credentials:APC ATR
Other - Prefix:
Other - First Name:LACY
Other - Middle Name:MCKAY
Other - Last Name:ADAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:757 SUGAR HILL LN SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-3743
Mailing Address - Country:US
Mailing Address - Phone:404-313-9807
Mailing Address - Fax:
Practice Address - Street 1:2375 WALL ST SE STE 240
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2296
Practice Address - Country:US
Practice Address - Phone:470-829-6301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA23-509221700000X
GA008510101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist