Individual
ANGIE RAE LACKEY DANIEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
65 MITCHELL STREET, MUNFORD, AL 36268
(256) 649-0910
Mailing address
PO BOX 955, MUNFORD, AL 36268-0955
(256) 649-0910
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3814
AL
101YP2500X
Professional Counselor
3814
AL
Other
Enumeration date
01/02/2018
Last updated
01/02/2018
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