Provider Demographics
NPI:1710183686
Name:JACKSON, LACEY H (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:H
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9247 NEW ZION RD
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANA
Mailing Address - State:TN
Mailing Address - Zip Code:37037-5206
Mailing Address - Country:US
Mailing Address - Phone:931-273-8888
Mailing Address - Fax:
Practice Address - Street 1:2723 NEW SALEM HWY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-5253
Practice Address - Country:US
Practice Address - Phone:615-396-6850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN73631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical