Provider Demographics
NPI:1902385396
Name:JAKOBSEN, KATELYN (LCMHC)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:JAKOBSEN
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 KEISLER DR STE 202
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-9309
Mailing Address - Country:US
Mailing Address - Phone:919-935-1901
Mailing Address - Fax:
Practice Address - Street 1:547 KEISLER DR STE 202
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-9309
Practice Address - Country:US
Practice Address - Phone:919-454-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NCA15293101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor