Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 0701009787 | VA |
N | 101YP2500X | Professional Counselor | 6321 | SC |
NPI | 1003278334 |
---|---|
Provider Name | Lacey Colleen Pickett |
First Address | Wytheville, VA 24382-1187 |
Second Address | Wytheville, VA 24382-2209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2016 |
Last Update Date | 02/09/2020 |