Healthcare Provider Details

I. General information

NPI: 1023555877
Provider Name (Legal Business Name): LACEY CARREL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S COLUMBUS ST
LANCASTER OH
43130-4315
US

IV. Provider business mailing address

3409 DRESDEN ROAD
ZANESVILLE OH
43701
US

V. Phone/Fax

Practice location:
  • Phone: 740-687-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: