| Doctor Name: | MR. ROBERT JOHN JACOBS |
| NPI Number: | 1336296847 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | 000826 |
| Business Practice Address: | 2378 Scotney Castle Ln Powder Springs, GA - 301275900 |
| Business Phone Number: | 2035269210 |
| Business Fax Number: | |
| Mailing Address: | 2378 Scotney Castle Ln, POWDER SPRINGS |
| State: | GA |
| Postal Code: | 301275900 |
| Phone Number: | 2035269210 |
| Fax Number: | |
| NPI Enumeration Date: | 01/05/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 000826 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |