Provider Demographics
NPI:1629404371
Name:JACOBS, MARQUII (BCABA)
Entity Type:Individual
Prefix:
First Name:MARQUII
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 LITCHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-7501
Mailing Address - Country:US
Mailing Address - Phone:912-373-5613
Mailing Address - Fax:305-597-3863
Practice Address - Street 1:105 GRAND CENTRAL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4146
Practice Address - Country:US
Practice Address - Phone:470-394-0004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program