Provider Demographics
NPI:1154017754
Name:LACY, ALESIA (LCPC)
Entity type:Individual
Prefix:MRS
First Name:ALESIA
Middle Name:
Last Name:LACY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 KENTSHIRE CIR SE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON COVE
Mailing Address - State:AL
Mailing Address - Zip Code:35763-9305
Mailing Address - Country:US
Mailing Address - Phone:256-298-0068
Mailing Address - Fax:
Practice Address - Street 1:2710 KENTSHIRE CIR SE
Practice Address - Street 2:
Practice Address - City:HAMPTON COVE
Practice Address - State:AL
Practice Address - Zip Code:35763-9305
Practice Address - Country:US
Practice Address - Phone:256-298-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.015133101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional