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NPI Code Detail

MEDICARE: MS. CATHERINE VERONICA JACOBS

MEDICARE: MS. CATHERINE VERONICA JACOBS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor1750821229

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255833299
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CATHERINE VERONICA JACOBS
Provider Business Mailing Address
First Line : 806 BELL FORK RD
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28540-6312
Country : US
Telephone Number : 910-347-2205
Fax Number : 910-347-2216
Provider Business Practice Location Address
First Line : 806 BELL FORK RD
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28540-6312
Country : US
Telephone Number : 910-347-2205
Fax Number : 910-347-2216
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2018
Last Update Date : 03/06/2018

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