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General NPI Number Information
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NPI Number | 1366047797
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Entity Type | Individual
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Provider Name | JACOB EDWARD HALBERT PSYD
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Gender | Male
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Dates
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Enumeration Date | 12/03/2020
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 7700 LEESBURG PIKE STE 101
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City | FALLS CHURCH
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State | VA
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Zip | 22043-2616
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Country | US
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Telephone | 703-790-5433
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Fax |
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Provider Business Mailing Address
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Address Line | 2038 PEACH ORCHARD DR APT 24
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City | FALLS CHURCH
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State | VA
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Zip | 22043-2064
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Country | US
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Telephone | 571-289-1085
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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