Healthcare Provider Details

I. General information

NPI: 1780237099
Provider Name (Legal Business Name): ALICIA JEREE JACKSON LCSW, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 CLINIC DR
MOREHEAD KY
40351-1077
US

IV. Provider business mailing address

304 VIKING DR
MOREHEAD KY
40351-2016
US

V. Phone/Fax

Practice location:
  • Phone: 606-748-9090
  • Fax:
Mailing address:
  • Phone: 606-748-9090
  • Fax: 606-740-0716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number266966
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number255943
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: