Provider Demographics
NPI:1972921906
Name:JACOBS, DANIELLE (LMHC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17027 W DIXIE HWY
Mailing Address - Street 2:SUITE 125
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3734
Mailing Address - Country:US
Mailing Address - Phone:784-449-8428
Mailing Address - Fax:
Practice Address - Street 1:17027 W DIXIE HWY
Practice Address - Street 2:SUITE 125
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-3734
Practice Address - Country:US
Practice Address - Phone:784-449-8428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11761101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health