Provider Demographics
NPI:1467588921
Name:JACOBSON, CAROLE J (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:J
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:CAROLE
Other - Middle Name:JOAN
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:600 MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3079
Mailing Address - Country:US
Mailing Address - Phone:425-771-6356
Mailing Address - Fax:
Practice Address - Street 1:600 MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3079
Practice Address - Country:US
Practice Address - Phone:425-771-6356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001769101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health