Provider Demographics
NPI:1144008582
Name:CAMPBELL, LACEY DANIELLE (LCSW)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:DANIELLE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2643 MCCURDY TRL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-4553
Mailing Address - Country:US
Mailing Address - Phone:704-352-3469
Mailing Address - Fax:
Practice Address - Street 1:3205 FREEDOM DR STE 2000
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-3486
Practice Address - Country:US
Practice Address - Phone:980-257-4811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0176281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical