Provider Demographics
NPI:1972240406
Name:DEMBICKI, LACEY M (LCSW)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:M
Last Name:DEMBICKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 N CENTRAL EXPY STE 400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-6712
Mailing Address - Country:US
Mailing Address - Phone:469-607-0076
Mailing Address - Fax:469-262-0178
Practice Address - Street 1:11300 N CENTRAL EXPY STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-6712
Practice Address - Country:US
Practice Address - Phone:469-607-0076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59878104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker