Individual
SUSAN G JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
154 DUCHESS STREET, NEWPORT, VT 05855
(802) 334-7451
(802) 334-7340
Mailing address
PO BOX 724, NEWPORT, VT 05855-0724
(802) 334-6744
(802) 334-7340
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
000468
VT
Other
Enumeration date
06/01/2009
Last updated
06/01/2009
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