Provider Demographics
NPI:1821540345
Name:JACOBS, STEPHANIE (LPCA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 ROLLING MARSH LN UNIT 101
Mailing Address - Street 2:
Mailing Address - City:HARDEEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29927-2760
Mailing Address - Country:US
Mailing Address - Phone:201-739-7918
Mailing Address - Fax:
Practice Address - Street 1:17-07 ROMAINE ST
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2150
Practice Address - Country:US
Practice Address - Phone:201-797-2660
Practice Address - Fax:201-797-5025
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8445101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health