Jessica Ann Jacobson, M.ED., LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

5624 Issued in SC

Practice address

302 Tom Hall St
Suite 5
Fort Mill, SC 29715-2338

Phone

(803) 701-0075

NPI assigned

Jul 8, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other names 1

• Ms. Jessica Ann Roman Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1278547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452902400000",
    "number": "1144532078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "968 ROCK FOREST WAY",
            "city": "INDIAN LAND",
            "state": "SC",
            "postal_code": "297074509",
            "telephone_number": "803-701-0075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 TOM HALL ST",
            "address_2": "SUITE 5",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297152338",
            "telephone_number": "803-701-0075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "JESSICA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "M.ED., LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-08",
        "last_updated": "2016-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "9517",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "SC",
            "license": "5624",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "ROMAN",
            "middle_name": "ANN",
            "prefix": "MS.",
            "credential": "M.ED.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Professional Counselor in Fort Mill, SC
• Providers in Fort Mill, SC by specialty
• Professional Counselor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.