Provider Demographics
NPI:1124293527
Name:JACOBSEN, SHARON LEA (MA LPC)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:LEA
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 YORKTOWN LANE
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512
Mailing Address - Country:US
Mailing Address - Phone:973-720-9057
Mailing Address - Fax:
Practice Address - Street 1:352 CLIFTON AVE
Practice Address - Street 2:CHRISTIAN COUNSELING CENTER
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011
Practice Address - Country:US
Practice Address - Phone:973-365-2125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00244300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional