Provider Demographics
NPI:1437529930
Name:JACOBSMA, ERICA ELLEN
Entity Type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:ELLEN
Last Name:JACOBSMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 MERCED ST STE 106
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1829
Mailing Address - Country:US
Mailing Address - Phone:559-981-2795
Mailing Address - Fax:
Practice Address - Street 1:2409 MERCED ST STE 106
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1829
Practice Address - Country:US
Practice Address - Phone:559-981-2795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)