Provider Demographics
NPI:1114654571
Name:JACOBS, JULYANA DENAE
Entity Type:Individual
Prefix:MS
First Name:JULYANA
Middle Name:DENAE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JULIYANA
Other - Middle Name:DENAE
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1628 BROADWAY ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-2405
Mailing Address - Country:US
Mailing Address - Phone:707-649-8300
Mailing Address - Fax:707-649-8302
Practice Address - Street 1:1628 BROADWAY ST UNIT B
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-2405
Practice Address - Country:US
Practice Address - Phone:707-363-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician