Individual
LARISSA M. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PLADC
Contact information
Practice address
8502 MORMON BRIDGE RD, OMAHA, NE 68152-1929
(402) 455-8303
Mailing address
3327 N 163RD PLZ APT 304, OMAHA, NE 68116-2149
(402) 510-0668
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
P-1781
NE
Other
Enumeration date
09/03/2020
Last updated
09/03/2020
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