Provider Demographics
NPI:1508317538
Name:JACOBS, DELLKAWAA (LMSW)
Entity Type:Individual
Prefix:MR
First Name:DELLKAWAA
Middle Name:
Last Name:JACOBS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:MR
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:120 E LIBERTY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2156
Mailing Address - Country:US
Mailing Address - Phone:734-585-6966
Mailing Address - Fax:
Practice Address - Street 1:120 E LIBERTY ST STE 200
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2156
Practice Address - Country:US
Practice Address - Phone:734-585-6966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801099473101YM0800X
MI68011090721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health