Individual
MRS. LAURA K JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW; LCDC III
Contact information
Practice address
3629 CHURCH ST, COVINGTON, KY 41015-1430
(859) 581-8974
(859) 581-9595
Mailing address
3629 CHURCH ST, COVINGTON, KY 41015-1430
(859) 581-8974
(859) 581-9595
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCDC III- 101140
OH
1041C0700X
Clinical Social Worker
Primary
LCSW 3952
KY
1041C0700X
Clinical Social Worker
LSW-09000933
OH
Other
Enumeration date
01/10/2008
Last updated
09/30/2014
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