Provider Demographics
NPI:1942773346
Name:LACRETA, JULIE (LACA)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:LACRETA
Suffix:
Gender:F
Credentials:LACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7808 SANTOLINA DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-3700
Mailing Address - Country:US
Mailing Address - Phone:317-437-7782
Mailing Address - Fax:
Practice Address - Street 1:399 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-3111
Practice Address - Country:US
Practice Address - Phone:317-885-1150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86900001A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)