Individual
DR. LACEY VIVIENNE MOFFATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD, LPC
Contact information
Practice address
648 ELMWOOD ST, SHREVEPORT, LA 71104-4902
(318) 470-5434
(318) 470-5434
Mailing address
648 ELMWOOD ST, SHREVEPORT, LA 71104-4902
(318) 470-5434
(318) 470-5434
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
68380
TX
Other
Enumeration date
04/28/2025
Last updated
04/28/2025
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