Provider Demographics
NPI:1699786657
Name:JACOBS, ROBERTA A (LPC)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:A
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:BOBBIE
Other - Middle Name:
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:1101 RIDGE ROAD
Mailing Address - Street 2:SUITE 226
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087
Mailing Address - Country:US
Mailing Address - Phone:903-454-6334
Mailing Address - Fax:903-454-1153
Practice Address - Street 1:1101 RIDGE ROAD
Practice Address - Street 2:SUITE 226
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087
Practice Address - Country:US
Practice Address - Phone:903-454-6334
Practice Address - Fax:903-454-1153
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18677101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional