Provider Demographics
NPI:1538656574
Name:ST. JACOBS, JESSICA LENOIR (LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LENOIR
Last Name:ST. JACOBS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S BROAD ST STE 1304
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19110-1004
Mailing Address - Country:US
Mailing Address - Phone:267-414-0181
Mailing Address - Fax:
Practice Address - Street 1:2901 ISLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19153-3013
Practice Address - Country:US
Practice Address - Phone:267-713-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010351101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health