Provider Demographics
NPI:1649475864
Name:LACY, JONI LYNN (BREINING)
Entity type:Individual
Prefix:MS
First Name:JONI
Middle Name:LYNN
Last Name:LACY
Suffix:
Gender:F
Credentials:BREINING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 SALVIO ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2193
Mailing Address - Country:US
Mailing Address - Phone:925-602-1750
Mailing Address - Fax:
Practice Address - Street 1:2380 SALVIO ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2193
Practice Address - Country:US
Practice Address - Phone:925-602-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL0503032057101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)