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1326146093

NPI Code Detail

MEDICARE: DR. CHARLAYNE LACKING

MEDICARE: DR. CHARLAYNE LACKING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	51299
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	51299
3	101YM0800X	Mental Health Counselor	87346	TX
4	101YM0800X	Mental Health Counselor	012590	GA
5	101YP2500X	Professional Counselor	87346	TX
6	101YP2500X	Professional Counselor	2405	LA
7	101YP2500X	Professional Counselor	012590	GA
8	106H00000X	Marriage & Family Therapist	153	LA
9	106H00000X	Marriage & Family Therapist	L573	AL

General Provider Information

NPI Number	:	1326146093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLAYNE LACKING

Provider Business Mailing Address
First Line	:	1307 SEATON CIR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-7220
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1307 SEATON CIR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-7220
Country	:	US
Telephone Number	:	337-802-0801
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	03/08/2023

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Directions to “ DR. CHARLAYNE LACKING ” Practice Location

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