Provider Demographics
NPI:1235377490
Name:GODFREY, JACOB J (PHD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:J
Last Name:GODFREY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 EUROPA DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-2357
Mailing Address - Country:US
Mailing Address - Phone:919-928-0144
Mailing Address - Fax:919-928-0145
Practice Address - Street 1:100 EUROPA DR
Practice Address - Street 2:SUITE 330
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-2357
Practice Address - Country:US
Practice Address - Phone:919-928-0144
Practice Address - Fax:919-928-0145
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3039103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist