Individual
MS. MARY E JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC CCAC
Contact information
Practice address
WATER STREET, FT ASHBY, WV 26719-0423
(304) 298-4082
(304) 298-4082
Mailing address
PO BOX 423, FORT ASHBY, WV 26719-0423
(304) 298-4082
(304) 298-4082
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
WVLPC 1016
WV
Other
Enumeration date
07/28/2006
Last updated
07/08/2007
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