Provider Demographics
NPI:1861053191
Name:JACOBS, NICHOLAS GRANT (MS)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:GRANT
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DOWD CIR STE A
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-7932
Mailing Address - Country:US
Mailing Address - Phone:910-295-2609
Mailing Address - Fax:800-948-6061
Practice Address - Street 1:5 DOWD CIR STE A
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-7932
Practice Address - Country:US
Practice Address - Phone:910-295-2609
Practice Address - Fax:800-948-6061
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-19-36212103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst