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General NPI Number Information
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NPI Number | 1275948093
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Entity Type | Individual
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Provider Name | LACEY POLLARD LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/01/2014
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Last Update Date | 06/09/2020
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Provider Practice Location Address
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Address Line | 1400 W CHURCH ST
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-4510
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Country | US
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Telephone | 252-331-0322
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Fax |
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Provider Business Mailing Address
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Address Line | 5569 NEW COLONY DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4010
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Country | US
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Telephone | 252-333-2652
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C010397
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License Number State | NC
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