Provider Demographics
NPI:1891533964
Name:JACOBSON, ERICA NICOLE (PCC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:NICOLE
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14976 RANCHERO RD
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-4156
Mailing Address - Country:US
Mailing Address - Phone:760-792-0406
Mailing Address - Fax:
Practice Address - Street 1:14976 RANCHERO RD
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-4156
Practice Address - Country:US
Practice Address - Phone:760-792-0406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC16707103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical