Provider Demographics
NPI:1912115114
Name:RACHEL LACY, PSY.D., P.C.
Entity Type:Organization
Organization Name:RACHEL LACY, PSY.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:KELLI
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:770-722-7827
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-0001
Mailing Address - Country:US
Mailing Address - Phone:770-722-7827
Mailing Address - Fax:770-962-1886
Practice Address - Street 1:1805 HERRINGTON RD BLDG 3-B
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-7987
Practice Address - Country:US
Practice Address - Phone:770-722-7827
Practice Address - Fax:770-760-0624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-19
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002801103G00000X, 103TA0700X, 103TB0200X, 103TC0700X, 103TF0200X, 103TH0004X, 103TM1800X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBGMZMedicare ID - Type UnspecifiedMEDICARE PART B
GAP00318238Medicare ID - Type UnspecifiedRAILROAD MEDICARE
GAQ42064Medicare UPIN