Provider Demographics
NPI:1992251482
Name:LACY, YASHICA M (MS, LCDC-I)
Entity type:Individual
Prefix:MRS
First Name:YASHICA
Middle Name:M
Last Name:LACY
Suffix:
Gender:F
Credentials:MS, LCDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6517 BIRDHOUSE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2827
Mailing Address - Country:US
Mailing Address - Phone:225-445-7538
Mailing Address - Fax:
Practice Address - Street 1:8515 EDNA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-4427
Practice Address - Country:US
Practice Address - Phone:702-262-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23268101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor