Provider Demographics
NPI:1255161923
Name:HENDRICKSON, LACEY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16192 COASTAL HWY
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-3608
Mailing Address - Country:US
Mailing Address - Phone:302-615-0599
Mailing Address - Fax:864-448-1738
Practice Address - Street 1:16192 COASTAL HWY
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-3608
Practice Address - Country:US
Practice Address - Phone:302-615-0599
Practice Address - Fax:864-448-1738
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0049609163W00000X
DEL8-0010687363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner