Provider Demographics
NPI:1447759675
Name:DACUS, LACEY
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:DACUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1842 GORDON VERNER CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-6137
Mailing Address - Country:US
Mailing Address - Phone:209-464-4524
Mailing Address - Fax:
Practice Address - Street 1:540 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2117
Practice Address - Country:US
Practice Address - Phone:209-464-4524
Practice Address - Fax:209-490-2732
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA145483106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist