Healthcare Provider Details

I. General information

NPI: 1073266334
Provider Name (Legal Business Name): SAVANNAH JEWEL LACKEY MSW, LCSW-A, LCAS-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 US 421 S
LILLINGTON NC
27546-6713
US

IV. Provider business mailing address

5841 US 421 S
LILLINGTON NC
27546-6713
US

V. Phone/Fax

Practice location:
  • Phone: 910-893-5727
  • Fax: 910-893-6404
Mailing address:
  • Phone: 108-935-7279
  • Fax: 910-893-6404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number27811
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP017168
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: