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Individual

LACEY TANK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1642 POWERS FERRY RD SE STE 100, MARIETTA, GA 30067-9489
(770) 565-3045
Mailing address
951 GLENWOOD AVE SE UNIT 2303, ATLANTA, GA 30316-6801

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-23-64419
GA
106E00000X
Assistant Behavior Analyst

Other

Enumeration date
03/01/2023
Last updated
03/13/2023
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