Individual
MICHELLE JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CASAC
Contact information
Practice address
6520 NIAGARA FALLS BLVD, NIAGARA FALLS, NY 14304-1550
(716) 831-1840
(716) 831-1839
Mailing address
3020 BAILEY AVE, BUFFALO, NY 14215-2814
(716) 831-1800
(716) 831-1818
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
8370
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8370
CASAC
NY
Enumeration date
11/02/2006
Last updated
07/08/2007
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