Organization
INGRID J LACEY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
INGRID JENNIFER LACEY LPC, BC-DMT, GLCMA (LICENSED PROFESSIONAL COUNSELOR)
(415) 913-8831
Entity
Organization
Contact information
Practice address
1799 CLAIRMONT RD, DECATUR, GA 30033-4005
(404) 490-0664
Mailing address
2156 CAVANAUGH AVE SE, ATLANTA, GA 30316-2706
(415) 913-8831
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
008680
GA
Other
Enumeration date
05/31/2018
Last updated
05/31/2018
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