Healthcare Provider Details

I. General information

NPI: 1679690283
Provider Name (Legal Business Name): CLINICAL, CULTURAL AND CONSULTING SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 NEW HAMPSHIRE AVE NW SUITE 700
WASHINGTON DC
20037-2346
US

IV. Provider business mailing address

908 NEW HAMPSHIRE AVE NW SUITE 700
WASHINGTON DC
20037-2346
US

V. Phone/Fax

Practice location:
  • Phone: 202-234-1742
  • Fax:
Mailing address:
  • Phone: 202-234-1742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number14701
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number14701
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number14701
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number14701
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number14701
License Number StateDC
# 6
Primary TaxonomyN
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License Number14701
License Number StateDC
# 7
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1342
License Number StateDC

VIII. Authorized Official

Name: DR. FREDERICK MARIUS JACOBSEN
Title or Position: CEO AND PRESIDENT
Credential: MD
Phone: 202-234-1742