Provider Demographics
NPI:1720808025
Name:SCARBOROUGH, LACEY MICHELLE (LMSW)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:MICHELLE
Last Name:SCARBOROUGH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 VERSAILLES BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2351
Mailing Address - Country:US
Mailing Address - Phone:318-787-6749
Mailing Address - Fax:318-321-1967
Practice Address - Street 1:710 VERSAILLES BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2351
Practice Address - Country:US
Practice Address - Phone:318-787-6749
Practice Address - Fax:318-321-1967
Is Sole Proprietor?:No
Enumeration Date:2024-10-12
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17349104100000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator