Most Relevant Information
Provider Data
| NPI Number: | 1003417585 |
| Provider Name: | ALEXIS JACOBS |
| Entity Type: | Individual |
| Taxonomy Code: | 320800000X |
| Specialty: | Community Based Residential Treatment Facility, Mental Illness |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/03/2020 |
| Last Updated: | 11/03/2020 |
Provider Practice Location
100 MONDAMIN RD
COLUMBIA
SC
292108216
Practice Location Phone/Fax
| Phone: | 8034797696 |
| Fax: |
Provider Mailing Location
100 MONDAMIN RD
COLUMBIA
SC
292108216
Provider Mailing Phone/Fax
| Phone: | 8034797696 |
| Fax: |