Individual
LACIE DEA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PLADC
Contact information
Practice address
1900 VICKI LN, NORFOLK, NE 68701-4558
(402) 370-3140
(402) 370-3373
Mailing address
1900 VICKI LN, NORFOLK, NE 68701-4558
(402) 370-3140
(402) 370-3373
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
P-2425
NE
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/17/2023
Last updated
05/18/2026
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