Provider Demographics
NPI:1316204803
Name:SAWYER, LACEY L (LCSW, CADCIII, LADC)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:L
Last Name:SAWYER
Suffix:
Gender:F
Credentials:LCSW, CADCIII, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 NE DIVISION ST STE 9B
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-3530
Mailing Address - Country:US
Mailing Address - Phone:415-233-8012
Mailing Address - Fax:
Practice Address - Street 1:2330 NE DIVISION ST STE 9B
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-3530
Practice Address - Country:US
Practice Address - Phone:541-233-8012
Practice Address - Fax:541-323-5834
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC6852101YA0400X
OR19-R-12101YA0400X
MELC152591041C0700X
ORL80821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)