Provider Demographics
NPI:1053950097
Name:SOBEL, JACOB (LCSW)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:
Last Name:SOBEL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3445 HIGHCROFT CIR
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4964
Mailing Address - Country:US
Mailing Address - Phone:678-923-4680
Mailing Address - Fax:
Practice Address - Street 1:3949 HOLCOMB BRIDGE RD STE 200
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-2208
Practice Address - Country:US
Practice Address - Phone:404-369-3985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-21
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW007491101YM0800X
GACSW0074421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1295492684OtherORGANIZATION NPI