Provider Demographics
NPI:1083402713
Name:HEAD, LACEY (LMSW, LGADC)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:HEAD
Suffix:
Gender:
Credentials:LMSW, LGADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12029 WARRENFELTZ LN
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-4498
Mailing Address - Country:US
Mailing Address - Phone:240-356-7078
Mailing Address - Fax:
Practice Address - Street 1:4500 BLACK ROCK RD STE 103
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:MD
Practice Address - Zip Code:21074-2649
Practice Address - Country:US
Practice Address - Phone:877-806-1501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD31583104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker