Provider Demographics
NPI:1962840819
Name:JACOBSEN, HEIDI JOAN (MS, LMHC M-CAP, LCPC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:JOAN
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:MS, LMHC M-CAP, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MARKET PLACE DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1680
Mailing Address - Country:US
Mailing Address - Phone:603-960-4185
Mailing Address - Fax:
Practice Address - Street 1:10 MARKET PLACE DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1680
Practice Address - Country:US
Practice Address - Phone:603-960-4185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4968101YA0400X
FLIMH9011101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)