Individual
DR. LACY KANTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
150 S CHURCH ST, FAIRHOPE, AL 36532-1569
(251) 928-5363
Mailing address
301 FREEDOM ST, FAIRHOPE, AL 36532-1331
(251) 605-5656
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2132
AL
103TC1900X
Counseling Psychologist
2132
AL
Other
Enumeration date
08/06/2019
Last updated
08/06/2019
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