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General NPI Number Information
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NPI Number | 1891099149
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Entity Type | Individual
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Provider Name | DEBORAH ANN JACOB-JOHNSON LPC
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Gender | Female
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Dates
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Enumeration Date | 12/30/2010
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Last Update Date | 12/30/2010
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Provider Practice Location Address
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Address Line | 101 W LOOMIS ST SUITE 206
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City | LUDINGTON
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State | MI
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Zip | 49431-2091
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Country | US
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Telephone | 231-845-7809
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Fax |
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Provider Business Mailing Address
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Address Line | 1025 N FERRY ST
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City | LUDINGTON
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State | MI
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Zip | 49431-1321
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Country | US
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Telephone | 231-233-2614
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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 | 6401010898
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License Number State | MI
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