MEDICARE: LACEY ATKINS LPCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	8460	SC

General Provider Information

NPI Number	:	1013690163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACEY ATKINS LPCA

Provider Business Mailing Address
First Line	:	1302 AUBRY DR
Second Line	:
City	:	MONCKS CORNER
State	:	SC
Zip	:	29461-9216
Country	:	US
Telephone Number	:	843-901-1650
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 W COLEMAN BLVD
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-3588
Country	:	US
Telephone Number	:	843-405-2869
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	08/07/2023

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