Provider Demographics
NPI:1396116687
Name:JACOBSON, LISA MARIE (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 ALLISON CIR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4325
Mailing Address - Country:US
Mailing Address - Phone:770-877-0246
Mailing Address - Fax:
Practice Address - Street 1:119 ALLISON CIR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4325
Practice Address - Country:US
Practice Address - Phone:770-877-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008638101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional