Provider Demographics
NPI:1184158925
Name:JAMISON, LACEYSHA (LPCA)
Entity type:Individual
Prefix:
First Name:LACEYSHA
Middle Name:
Last Name:JAMISON
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MIDDELEGROUND WAY
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744
Mailing Address - Country:US
Mailing Address - Phone:606-657-5470
Mailing Address - Fax:606-657-5472
Practice Address - Street 1:21 MIDDELEGROUND WAY
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40744
Practice Address - Country:US
Practice Address - Phone:606-657-5470
Practice Address - Fax:606-657-5472
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY127827101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional