Provider Demographics
NPI:1225363617
Name:JACOBSON, REBECCA R (PHD LPC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:R
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:PHD LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7085 SYDNEY CURV
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3509
Mailing Address - Country:US
Mailing Address - Phone:334-270-5502
Mailing Address - Fax:334-270-5503
Practice Address - Street 1:7085 SYDNEY CURV
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3509
Practice Address - Country:US
Practice Address - Phone:334-270-5502
Practice Address - Fax:334-270-5503
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2555101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health