Individual
JACKELYN MARIE LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
106 E. MAIN ST., SPRINGFIELD, OH 45503
(937) 284-0744
Mailing address
310 UNION ST APT 109, YELLOW SPRINGS, OH 45387-2033
(937) 321-6564
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCDCII.161835
OH
Other
Enumeration date
03/03/2025
Last updated
03/03/2025
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