Individual
MARK JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
251 JOHNSTON ST SE STE 100, DECATUR, AL 35601-2515
(256) 822-2375
Mailing address
16 MOULTON ST E, DECATUR, AL 35601-2310
(256) 822-2375
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1081C
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51522567
BCBS
AL
Enumeration date
05/24/2006
Last updated
01/25/2023
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