Individual
WANDA LACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3450 HIGHWAY 80 W, JACKSON, MS 39209-7201
(601) 321-2497
(601) 321-2476
Mailing address
3450 HIGHWAY 80 W, JACKSON, MS 39209-7201
(601) 321-2497
(601) 321-2476
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1788
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018209
—
MS
Enumeration date
09/26/2013
Last updated
09/26/2013
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