Provider Demographics
NPI:1457023293
Name:JACKSON, LAKYA (MS, BCBA-LBA)
Entity type:Individual
Prefix:
First Name:LAKYA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MS, BCBA-LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5451 N UNIVERSITY DR APT 6510
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33351-5084
Mailing Address - Country:US
Mailing Address - Phone:608-371-2577
Mailing Address - Fax:
Practice Address - Street 1:2919 BREEZEWOOD AVE STE 202
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5283
Practice Address - Country:US
Practice Address - Phone:910-263-8986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-25-81973103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst