Provider Demographics
NPI:1922699438
Name:JACOBS, CHARMAINE CURTIS (LMFT 123172)
Entity Type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:CURTIS
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LMFT 123172
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7127 HOLLISTER AVE # 25A-190
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-2859
Mailing Address - Country:US
Mailing Address - Phone:805-886-7024
Mailing Address - Fax:
Practice Address - Street 1:7127 HOLLISTER AVE # 25A-190
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-2859
Practice Address - Country:US
Practice Address - Phone:805-886-7024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123172106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist