Provider Demographics
NPI:1316686363
Name:LACKEY, ERICA NICOLE (LPC)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:NICOLE
Last Name:LACKEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:ERICA
Other - Middle Name:NICOLE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:329 BLUE RIBBON RD
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-8722
Mailing Address - Country:US
Mailing Address - Phone:972-268-4479
Mailing Address - Fax:
Practice Address - Street 1:4204 SW GREEN OAKS BLVD STE 120
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-4159
Practice Address - Country:US
Practice Address - Phone:682-422-9123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-28
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84437101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor