Individual
LACREZIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
7025 HARBOUR VIEW BLVD STE 119, SUFFOLK, VA 23435-2762
(757) 966-2805
(757) 673-6135
Mailing address
7025 HARBOUR VIEW BLVD STE 119, SUFFOLK, VA 23435-2762
(757) 966-2805
(757) 673-6135
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904010568
VA
Other
Enumeration date
07/31/2018
Last updated
07/31/2018
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