Provider Demographics
NPI:1336573567
Name:LACKEY, DESIREE MORRELL (MS, CAS, LPC-A)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:MORRELL
Last Name:LACKEY
Suffix:
Gender:F
Credentials:MS, CAS, LPC-A
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:MARIE
Other - Last Name:MORRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CAS, LPC-A
Mailing Address - Street 1:3149 HARMON RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-1775
Mailing Address - Country:US
Mailing Address - Phone:315-430-3870
Mailing Address - Fax:
Practice Address - Street 1:175 W FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4145
Practice Address - Country:US
Practice Address - Phone:704-865-3525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8306101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor