Individual
PHYLLIS J LACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LIC PROF COUNSELOR
Contact information
Practice address
482 N DETROIT ST, XENIA, OH 45385
(937) 374-6010
(937) 374-6014
Mailing address
76 FORDWAY DR, SUITE 2, VANDALIA, OH 45377
(937) 890-3139
(937) 890-3111
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
C0003153
OH
Other
Enumeration date
12/08/2006
Last updated
07/08/2007
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