Provider Demographics
NPI:1538401450
Name:LACKEY, CAMERON ELAINE (MS, BCBA)
Entity type:Individual
Prefix:MISS
First Name:CAMERON
Middle Name:ELAINE
Last Name:LACKEY
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 COOSA COUNTY ROAD 49
Mailing Address - Street 2:
Mailing Address - City:GOODWATER
Mailing Address - State:AL
Mailing Address - Zip Code:35072-6309
Mailing Address - Country:US
Mailing Address - Phone:256-404-6669
Mailing Address - Fax:
Practice Address - Street 1:2701 COOSA COUNTY ROAD 49
Practice Address - Street 2:
Practice Address - City:GOODWATER
Practice Address - State:AL
Practice Address - Zip Code:35072-6309
Practice Address - Country:US
Practice Address - Phone:256-404-6669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2023-016103K00000X
AL1-12-12293103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst