Provider Demographics
NPI:1912153727
Name:ANDERSON, LACEY DAWN (LPC)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:DAWN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:DAWN
Other - Last Name:ARRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:530 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-5006
Mailing Address - Country:US
Mailing Address - Phone:210-558-8744
Mailing Address - Fax:210-558-4276
Practice Address - Street 1:530 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5006
Practice Address - Country:US
Practice Address - Phone:210-558-8744
Practice Address - Fax:210-558-4276
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62085101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional