Individual
LACREISHA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
211 LUNTSFORD LN, RUSTON, LA 71270-5967
(918) 202-3789
Mailing address
211 LUNTSFORD LN, RUSTON, LA 71270-5967
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
12/14/2023
Last updated
12/14/2023
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