Basic Information
| Provider Information | |||||||||
| NPI: | 1841493533 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JACOBS | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | CHERYL | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 176 BADGETT AVE | ||||||||
| Address2: | |||||||||
| City: | MT. AIRY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367861166 | ||||||||
| FaxNumber: | 3367866312 | ||||||||
| Practice Location | |||||||||
| Address1: | 414 W LEBANON ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT AIRY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270302954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367899492 | ||||||||
| FaxNumber: | 3367899587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2007 | ||||||||
| LastUpdateDate: | 09/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 6540 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.