Individual
MRS. THERESA JACOBSEN JACOBSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA, CAC III
Contact information
Practice address
25 E 16TH AVE, BOX 4, DENVER, CO 80202-5195
(720) 327-2940
(303) 764-6270
Mailing address
11721 HARRISON ST, THORNTON, CO 80233-1623
(303) 451-9377
(303) 452-4978
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1638
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1638
COLORADO ADDICTIONS COUNSELOR
CO
Enumeration date
04/01/2010
Last updated
04/01/2010
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