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General NPI Number Information
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NPI Number | 1194378935
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Entity Type | Individual
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Provider Name | BRIAN DANIEL JACOBS LPC
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Gender | Male
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Dates
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Enumeration Date | 07/22/2019
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Last Update Date | 09/08/2019
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Provider Practice Location Address
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Address Line | 1655 FORT MYER DR STE 820
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City | ARLINGTON
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State | VA
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Zip | 22209-3106
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Country | US
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Telephone | 908-304-3718
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Fax |
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Provider Business Mailing Address
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Address Line | 3346 S WAKEFIELD ST APT B1
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City | ARLINGTON
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State | VA
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Zip | 22206-1726
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Country | US
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Telephone | 908-304-3718
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701008495
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License Number State | VA
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