Healthcare Provider Details

I. General information

NPI: 1083436281
Provider Name (Legal Business Name): LACY DELANE ANDERSON MACMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3309 CUMMINGS HIGHWAY SUITE 110
CHATTANOOGA TN
37419
US

IV. Provider business mailing address

382 CHERRY STREET #413
CHATTANOOGA TN
37403-1020
US

V. Phone/Fax

Practice location:
  • Phone: 423-933-2575
  • Fax:
Mailing address:
  • Phone: 423-503-1458
  • Fax: 423-503-1458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: