Healthcare Provider Details

I. General information

NPI: 1427988625
Provider Name (Legal Business Name): JACOB HARRELL MS, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WETZEL DR STE 3
HANOVER PA
17331-1131
US

IV. Provider business mailing address

6680 PINE RD
THOMASVILLE PA
17364-9441
US

V. Phone/Fax

Practice location:
  • Phone: 717-797-3796
  • Fax:
Mailing address:
  • Phone: 717-852-5193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number23164
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: