| Doctor Name: | ANTONIO D LACEY |
| NPI Number: | 1093057382 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | |
| Business Practice Address: | 1324 Crestmark Blvd Lithia Springs, GA - 301224428 |
| Business Phone Number: | 7707283468 |
| Business Fax Number: | 4045916748 |
| Mailing Address: | 1324 Crestmark Blvd, LITHIA SPRINGS |
| State: | GA |
| Postal Code: | 301224428 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/25/2013 |
| NPI Last Update Date: | 03/25/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |