Healthcare Provider Details

I. General information

NPI: 1881131944
Provider Name (Legal Business Name): JANIE LACY & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 N ORLANDO AVE SUITE 103
MAITLAND FL
32751
US

IV. Provider business mailing address

670 N ORLANDO AVE SUITE 103
MAITLAND FL
32751
US

V. Phone/Fax

Practice location:
  • Phone: 407-622-1770
  • Fax:
Mailing address:
  • Phone: 407-622-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JANIE LACY
Title or Position: PRESIDENT/ OWNER
Credential: LMHC, NCC, CSAT
Phone: 407-622-1770