Individual
SUSAN CHARLOTTE JACOBSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
64 INDIAN RUN TRL, WAKEFIELD, RI 02879-1908
(401) 742-1430
Mailing address
64 INDIAN RUN TRL, WAKEFIELD, RI 02879-1908
(401) 742-1430
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MHC00294
RI
Other
Enumeration date
02/09/2007
Last updated
07/08/2007
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