Individual
LACEY MICHELLE LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1007 W CONGRESS ST, BROOKHAVEN, MS 39601-2603
(601) 327-1225
Mailing address
1007 W CONGRESS ST, BROOKHAVEN, MS 39601-2603
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C8769
MS
Other
Enumeration date
12/11/2021
Last updated
12/11/2021
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