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General NPI Number Information
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NPI Number | 1033794490
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Entity Type | Individual
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Provider Name | ABIGAIL SUSAN LACEY MA
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Gender | Female
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Dates
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Enumeration Date | 03/16/2021
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Last Update Date | 07/27/2023
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Provider Practice Location Address
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Address Line | 3613 WILLIAMS DR STE 302
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City | GEORGETOWN
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State | TX
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Zip | 78628-1369
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Country | US
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Telephone | 512-713-9886
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Fax |
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Provider Business Mailing Address
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Address Line | 4801 MALLARD LN
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City | KILLEEN
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State | TX
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Zip | 76542-3787
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Country | US
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Telephone | 850-603-0726
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | IMH20788
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 91552
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License Number State | TX
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