Provider Demographics
NPI:1558699918
Name:JACOBS, AMBER ELIZABETH (LMSW)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:ELIZABETH
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12220 E 13 MILE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-5000
Mailing Address - Country:US
Mailing Address - Phone:586-573-1810
Mailing Address - Fax:586-573-2121
Practice Address - Street 1:12220 E 13 MILE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-5000
Practice Address - Country:US
Practice Address - Phone:586-573-1810
Practice Address - Fax:586-573-2121
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010893251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical