Provider Demographics
NPI:1730508268
Name:O'ROURKE, LACEY NICOLE
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:NICOLE
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:
Other - Last Name:HESKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 QUAIL DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-7204
Mailing Address - Country:US
Mailing Address - Phone:828-320-8824
Mailing Address - Fax:
Practice Address - Street 1:200 ENOLA RD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4606
Practice Address - Country:US
Practice Address - Phone:828-432-7508
Practice Address - Fax:828-608-5705
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10572101YM0800X
NCA10572101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health