Healthcare Provider Details

I. General information

NPI: 1972584662
Provider Name (Legal Business Name): JAMES FRANKLIN JACOBS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N 5TH AVE
HOPEWELL VA
23860-2509
US

IV. Provider business mailing address

10807 STERLING COVE DR
CHESTERFIELD VA
23838-5247
US

V. Phone/Fax

Practice location:
  • Phone: 804-586-7017
  • Fax: 804-748-9517
Mailing address:
  • Phone: 804-586-7017
  • Fax: 804-748-9517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0718000210
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number14421
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717000722
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF00000856
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number004765
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: