Provider Demographics
NPI:1043957418
Name:LACY, KANDICE SHERICE (LISW-S)
Entity type:Individual
Prefix:
First Name:KANDICE
Middle Name:SHERICE
Last Name:LACY
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 MUNROE FALLS AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-3487
Mailing Address - Country:US
Mailing Address - Phone:330-808-7373
Mailing Address - Fax:
Practice Address - Street 1:650 DAN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-3989
Practice Address - Country:US
Practice Address - Phone:330-643-2861
Practice Address - Fax:330-643-7758
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.20024691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical