Provider Demographics
NPI:1417652009
Name:JACOBS, JESSIE K (LICSW)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:K
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 SAGE OAK DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-7523
Mailing Address - Country:US
Mailing Address - Phone:662-231-8485
Mailing Address - Fax:
Practice Address - Street 1:115 SAGE OAK DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-7523
Practice Address - Country:US
Practice Address - Phone:662-231-8485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5308C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical