Provider Demographics
NPI:1780910554
Name:CARROLL, LACEY DAWN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:DAWN
Last Name:CARROLL
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 1:245 S MADISON BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-2822
Mailing Address - Country:US
Mailing Address - Phone:918-336-1463
Mailing Address - Fax:918-331-9717
Practice Address - Street 1:245 S MADISON BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2822
Practice Address - Country:US
Practice Address - Phone:918-336-1463
Practice Address - Fax:918-331-9717
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK49371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical