Provider Demographics
NPI:1891099149
Name:JACOB-JOHNSON, DEBORAH ANN (LPC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:JACOB-JOHNSON
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 1:1025 N FERRY ST
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1321
Mailing Address - Country:US
Mailing Address - Phone:231-233-2614
Mailing Address - Fax:
Practice Address - Street 1:101 W LOOMIS ST
Practice Address - Street 2:SUITE 206
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2091
Practice Address - Country:US
Practice Address - Phone:231-845-7809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010898101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor