Provider Information for 1902158918
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LACY MICHELLE ALLEN WATKINS LMHC, CAP, DCC
Other Names:Former Name:LACY MICHELLE ALLEN LMHC, CAP, DCCSex: Female
NPI: 1902158918
Last Updated: 2012-10-15
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1902158918 | ||||||||||||
| Enumeration Date | 2012-10-15 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 704 SAMUEL CHASE LN WEST MELBOURNE, FL 32904-7501 United States Phone: 321-432-5119 | Fax: | ||||||||||||
| Primary Practice Address | 906 PEACHTREE ST COCOA, FL 32922-7223 United States Phone: 321-806-2846 | Fax: | ||||||||||||
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