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NPI Code Detail

MEDICARE: DORETTA JACOBS

MEDICARE: DORETTA 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
1101YM0800XMental Health Counselor2743ANC

General Provider Information

NPI Number : 1598018335
Entity Type Code : Individual
Provider Name (Legal Business Name) : DORETTA JACOBS
Provider Business Mailing Address
First Line : 3581 LACKEY ST
Second Line :
City : LUMBERTON
State : NC
Zip : 28360-9048
Country : US
Telephone Number : 910-738-5023
Fax Number : 910-738-1581
Provider Business Practice Location Address
First Line : 3581 LACKEY ST
Second Line :
City : LUMBERTON
State : NC
Zip : 28360-9048
Country : US
Telephone Number : 910-738-5023
Fax Number : 910-738-1581
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2012
Last Update Date : 10/17/2012

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Directions to “ DORETTA JACOBS ” Practice Location

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