Provider Demographics
NPI:1750305314
Name:JACOBS, MARSHA WOLFE (MFT)
Entity type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:WOLFE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5934 VINE HILL SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-2026
Mailing Address - Country:US
Mailing Address - Phone:707-527-5205
Mailing Address - Fax:707-823-5924
Practice Address - Street 1:5934 VINE HILL SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-2026
Practice Address - Country:US
Practice Address - Phone:707-527-5205
Practice Address - Fax:707-823-5924
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT24481106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist