Provider Demographics
NPI:1891447876
Name:JACOBS, KRYSTIN DALE (LMFT-A)
Entity Type:Individual
Prefix:MS
First Name:KRYSTIN
Middle Name:DALE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 SWAIM DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-4015
Mailing Address - Country:US
Mailing Address - Phone:704-904-7344
Mailing Address - Fax:
Practice Address - Street 1:202 N STEWART ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4767
Practice Address - Country:US
Practice Address - Phone:704-904-7344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12332A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health