Provider Demographics
NPI:1386935369
Name:LACY, ANDREA LEIGH (LCDC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEIGH
Last Name:LACY
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 WEST NOLANA LOOP
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577
Mailing Address - Country:US
Mailing Address - Phone:956-502-5526
Mailing Address - Fax:956-502-5528
Practice Address - Street 1:918 W NOLANA LOOP
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-8340
Practice Address - Country:US
Practice Address - Phone:956-502-5526
Practice Address - Fax:956-502-5528
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLCDC 2700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)