Individual
STEPHANIE LACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW & LMFT
Contact information
Practice address
142 FORREST AVE, GAINESVILLE, GA 30501
(404) 345-7062
Mailing address
PO BOX 908023, GAINESVILLE, GA 30501-0916
(770) 534-8832
(770) 531-7479
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1502
GA
106H00000X
Marriage & Family Therapist
734
GA
Other
Enumeration date
07/31/2006
Last updated
06/22/2021
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