Provider Demographics
NPI:1053495150
Name:JACOBS, EMILY MCCLINTIC (LCSW)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:MCCLINTIC
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO 973
Mailing Address - Street 2:SAN ANDREAS
Mailing Address - City:SAN ANDREAS
Mailing Address - State:CA
Mailing Address - Zip Code:95249
Mailing Address - Country:US
Mailing Address - Phone:209-304-2924
Mailing Address - Fax:209-772-2094
Practice Address - Street 1:10 B VISTA DEL LAGO
Practice Address - Street 2:SUITE #3
Practice Address - City:VALLEY SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95252
Practice Address - Country:US
Practice Address - Phone:209-304-2924
Practice Address - Fax:209-772-2094
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95141041C0700X
CALCS95141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical