Individual
MRS. LORI JACKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
130 MILL CENTER BLVD, ATHENS, GA 30606-0835
(706) 621-9611
Mailing address
130 MILL CENTER BLVD, ATHENS, GA 30606-0835
(706) 621-9611
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
MSW008915
GA
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
07/11/2019
Last updated
02/06/2026
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