Individual
MICHAEL RALPH JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2825 W 42ND AVE, ANCHORAGE, AK 99517-2830
(907) 243-5130
Mailing address
2825 W 42ND AVE, ANCHORAGE, AK 99517-2830
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101YA0400X
NA
—
Enumeration date
06/26/2019
Last updated
06/26/2019
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