Individual
MARK IRWIN LACKMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADAC I; CADC I
Contact information
Practice address
661 MADISON AVE, MEMPHIS, TN 38103-3307
(901) 267-4008
Mailing address
3045 LEERIDGE DR, BARTLETT, TN 38134-3613
(505) 402-3138
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LDC0000001357
TN
101YA0400X
Addiction (Substance Use Disorder) Counselor
TN-006
TN
Other
Enumeration date
11/17/2023
Last updated
11/17/2023
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