Individual
MRS. DORA LENA JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MPC, LCASA
Contact information
Practice address
86 THREE HUNTS DRIVE, PEMBROKE, NC 28372
(910) 522-0408
(910) 522-0465
Mailing address
PO BOX 3781, PEMBROKE, NC 28372-3781
(910) 522-0408
(910) 522-0465
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
21930
NC
Other
Enumeration date
06/09/2020
Last updated
06/09/2020
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