Provider Demographics
NPI:1306226824
Name:JACOBS, SHERI (LCPAT)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LCPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 EDMONDSON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1901
Mailing Address - Country:US
Mailing Address - Phone:410-744-0855
Mailing Address - Fax:
Practice Address - Street 1:819 RITCHIE HIGHWAY
Practice Address - Street 2:SUITE 1020
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146
Practice Address - Country:US
Practice Address - Phone:410-431-5111
Practice Address - Fax:410-431-5112
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDATC013101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health