Provider Demographics
NPI:1285285635
Name:LACKEY, KRISTIN CAROL (LMFTA)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:CAROL
Last Name:LACKEY
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 18TH AVENUE DR NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-1826
Mailing Address - Country:US
Mailing Address - Phone:204-451-5291
Mailing Address - Fax:
Practice Address - Street 1:1015 2ND ST NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3887
Practice Address - Country:US
Practice Address - Phone:828-409-6743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12175A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist