Provider Demographics
NPI:1245050574
Name:JACOBS, HEATHER F (LPCA)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:F
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-6374
Mailing Address - Country:US
Mailing Address - Phone:860-888-4400
Mailing Address - Fax:
Practice Address - Street 1:1 HOPE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-6374
Practice Address - Country:US
Practice Address - Phone:860-888-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7192101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor