Provider Demographics
NPI:1699154898
Name:LACKEY, RICHARD (LISW-CP, LAC, CACII)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:LACKEY
Suffix:
Gender:M
Credentials:LISW-CP, LAC, CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 SYCAMORE AVE APT 737
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6726
Mailing Address - Country:US
Mailing Address - Phone:412-508-8275
Mailing Address - Fax:
Practice Address - Street 1:763 MEETING ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-3146
Practice Address - Country:US
Practice Address - Phone:412-508-8275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2019-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
SC113911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)