Healthcare Provider Details

I. General information

NPI: 1508411620
Provider Name (Legal Business Name): JACOB SETTLE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8527 MAYLAND DR STE 101
RICHMOND VA
23294-4753
US

IV. Provider business mailing address

1702 GREENVILLE AVE
RICHMOND VA
23220-6919
US

V. Phone/Fax

Practice location:
  • Phone: 804-346-5165
  • Fax: 804-346-5167
Mailing address:
  • Phone: 804-317-2922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701008481
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: