Provider Demographics
NPI:1972015626
Name:SEMENOK, LACEY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:
Last Name:SEMENOK
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 1:10299 GRAND RIVER RD STE P
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-9558
Mailing Address - Country:US
Mailing Address - Phone:810-225-9550
Mailing Address - Fax:
Practice Address - Street 1:10299 GRAND RIVER RD STE P
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-9558
Practice Address - Country:US
Practice Address - Phone:810-225-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401223303101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor