Provider Demographics
NPI:1679957237
Name:JAKOBCIC, ANDREW VINCENT (LLPC)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:VINCENT
Last Name:JAKOBCIC
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12015 56TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-9161
Mailing Address - Country:US
Mailing Address - Phone:616-821-8650
Mailing Address - Fax:
Practice Address - Street 1:1611 OAK AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-2468
Practice Address - Country:US
Practice Address - Phone:231-724-6439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014473101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health