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General NPI Number Information
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NPI Number | 1821366030
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Entity Type | Individual
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Provider Name | NIKESHA D JACOBS LPC
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Gender | Female
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Dates
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Enumeration Date | 12/02/2011
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Last Update Date | 12/02/2011
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Provider Practice Location Address
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Address Line | 2712 MIDDLEBURG DR STE 206
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City | COLUMBIA
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State | SC
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Zip | 29204-2415
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Country | US
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Telephone | 803-779-0169
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Fax |
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Provider Business Mailing Address
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Address Line | 3946 DAVIES DR
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City | COLUMBIA
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State | SC
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Zip | 29223-4775
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Country | US
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Telephone | 843-324-3584
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5125
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License Number State | SC
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