Provider Demographics
NPI:1184328213
Name:WITTE, LACEY LYNNE (BS, CIT)
Entity type:Individual
Prefix:MS
First Name:LACEY
Middle Name:LYNNE
Last Name:WITTE
Suffix:
Gender:F
Credentials:BS, CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 S FOSTER DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4103
Mailing Address - Country:US
Mailing Address - Phone:225-389-3325
Mailing Address - Fax:
Practice Address - Street 1:216 S FOSTER DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4103
Practice Address - Country:US
Practice Address - Phone:225-389-3325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACIT-5603101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)