Healthcare Provider Details

I. General information

NPI: 1831700863
Provider Name (Legal Business Name): LACIE MEHR LCGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 OGLETOWN STANTON RD STE 2200
NEWARK DE
19713-7000
US

IV. Provider business mailing address

4701 OGLETOWN STANTON RD STE 2200
NEWARK DE
19713-7000
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-4593
  • Fax:
Mailing address:
  • Phone: 302-623-4593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberCG-P010025
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: