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General NPI Number Information
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NPI Number | 1891562930
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Entity Type | Individual
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Provider Name | LACY MCKAY ADAMSON WEST APC ATR
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Gender | Female
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Dates
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Enumeration Date | 12/08/2023
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Last Update Date | 12/08/2023
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Provider Practice Location Address
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Address Line | 2375 WALL ST SE STE 240
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City | CONYERS
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State | GA
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Zip | 30013-2296
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Country | US
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Telephone | 470-829-6301
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Fax |
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Provider Business Mailing Address
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Address Line | 757 SUGAR HILL LN SE
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City | CONYERS
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State | GA
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Zip | 30094-3743
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Country | US
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Telephone | 404-313-9807
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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 | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 23-509
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 008510
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License Number State | GA
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