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Individual

MRS. JENNIFER ODESSA LACKNETT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MSW,LSW,LCDC III

Contact information

Practice address
30 S 4TH ST, NEWARK, OH 43055-5002
(614) 334-6903
Mailing address
5559 RAIDERS ROAD, FRAZEYBURG, OH 43822

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LICDC.162436
OH
101YM0800X
Mental Health Counselor
S.2004927
OH

Other

Enumeration date
06/27/2017
Last updated
03/17/2024
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