Provider Demographics
NPI:1194378935
Name:JACOBS, BRIAN DANIEL (LPC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DANIEL
Last Name:JACOBS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3346 S WAKEFIELD ST APT B1
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-1726
Mailing Address - Country:US
Mailing Address - Phone:908-304-3718
Mailing Address - Fax:
Practice Address - Street 1:1655 FORT MYER DR STE 820
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-3106
Practice Address - Country:US
Practice Address - Phone:908-304-3718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008495101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional