Provider Demographics
NPI:1992906770
Name:JACOBS, CYNTHIA CAMPBELL (MS CRC, LPC)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:CAMPBELL
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MS CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 BEACHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-9271
Mailing Address - Country:US
Mailing Address - Phone:919-777-3350
Mailing Address - Fax:
Practice Address - Street 1:215 BRACKEN ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-3925
Practice Address - Country:US
Practice Address - Phone:919-777-3350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2018-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4891101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103608Medicaid