Individual
LACEY MARIE BURKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMH
Contact information
Practice address
120 SE 4TH AVE, DELRAY BEACH, FL 33483-4516
(561) 266-8866
(556) 404-4735
Mailing address
403 SE 1ST ST, DELRAY BEACH, FL 33483-4540
(561) 266-8866
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PMH1655
STATE OF FLORIDA
FL
Enumeration date
08/10/2021
Last updated
08/10/2021
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