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General NPI Number Information
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NPI Number | 1316403678
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Entity Type | Individual
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Provider Name | AMANDA COLLEY JACOBSON LPC, CAADC
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Gender | Female
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Dates
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Enumeration Date | 02/12/2019
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 800 MONROE AVE NW STE 217
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-1451
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Country | US
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Telephone | 248-935-5135
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Fax |
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Provider Business Mailing Address
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Address Line | 4593 CANTERWOOD DR NE
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City | ADA
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State | MI
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Zip | 49301-8712
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Country | US
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Telephone | 248-935-5135
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401019189
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | MI
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