Provider Demographics
NPI:1376986976
Name:JACOBS, HAZEL (LCSW, LISW-CP)
Entity Type:Individual
Prefix:
First Name:HAZEL
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LCSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10120 TWO NOTCH RD # 361
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4395
Mailing Address - Country:US
Mailing Address - Phone:803-262-7486
Mailing Address - Fax:843-459-7987
Practice Address - Street 1:10120 TWO NOTCH RD # 361
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4395
Practice Address - Country:US
Practice Address - Phone:803-262-7486
Practice Address - Fax:843-459-7987
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040081991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical