Provider Demographics
NPI:1407872229
Name:JACOBS, JAMIE L (LMHP, CPC, LPC, LADC)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:L
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LMHP, CPC, LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 CHATEAU DR SE
Mailing Address - Street 2:T-2
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-6616
Mailing Address - Country:US
Mailing Address - Phone:404-663-0597
Mailing Address - Fax:
Practice Address - Street 1:400 SYCAMORE LN
Practice Address - Street 2:APT 208
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-7315
Practice Address - Country:US
Practice Address - Phone:404-663-0597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE537101YA0400X
NE2297101YM0800X
NE1276101YP2500X
GA005516101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health