Provider Demographics
NPI:1245631761
Name:JACOBS, JESSICA FAITH SARA (LPCA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:FAITH SARA
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:FAITH SARA
Other - Last Name:HARKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 JANEWAY
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-1536
Mailing Address - Country:US
Mailing Address - Phone:740-591-6550
Mailing Address - Fax:
Practice Address - Street 1:313 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2757
Practice Address - Country:US
Practice Address - Phone:864-323-4773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8543101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor