Provider Demographics
NPI:1861154072
Name:JACOBS, ATIYA JHENI (NONE)
Entity type:Individual
Prefix:
First Name:ATIYA
Middle Name:JHENI
Last Name:JACOBS
Suffix:
Gender:F
Credentials:NONE
Other - Prefix:
Other - First Name:ATIYA
Other - Middle Name:JHENI
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NONE
Mailing Address - Street 1:7090 SAMUEL MORSE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-3444
Mailing Address - Country:US
Mailing Address - Phone:888-344-5977
Mailing Address - Fax:
Practice Address - Street 1:7090 SAMUEL MORSE DR STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3444
Practice Address - Country:US
Practice Address - Phone:888-344-5977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician