Provider Demographics
NPI:1952856288
Name:XEPOLEAS, LACEY (PSYD)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:XEPOLEAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:DAWN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, MA
Mailing Address - Street 1:1170 BRIONES RD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-9766
Mailing Address - Country:US
Mailing Address - Phone:925-392-4003
Mailing Address - Fax:
Practice Address - Street 1:4155 BLACKHAWK PLAZA CIR STE 101
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4829
Practice Address - Country:US
Practice Address - Phone:925-984-2326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist