Provider Demographics
NPI:1083436281
Name:ANDERSON, LACY DELANE (MACMHC)
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:DELANE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 CHERRY STREET
Mailing Address - Street 2:#413
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-1020
Mailing Address - Country:US
Mailing Address - Phone:423-503-1458
Mailing Address - Fax:423-503-1458
Practice Address - Street 1:3309 CUMMINGS HIGHWAY
Practice Address - Street 2:SUITE 110
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37419
Practice Address - Country:US
Practice Address - Phone:423-933-2575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional