Provider Demographics
NPI:1336667922
Name:JACOBY, DOLORES P, (MSW, D DIV,PHD)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:P,
Last Name:JACOBY
Suffix:
Gender:F
Credentials:MSW, D DIV,PHD
Other - Prefix:DR
Other - First Name:DOLORES
Other - Middle Name:P
Other - Last Name:JACOBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:716 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-8051
Mailing Address - Country:US
Mailing Address - Phone:561-385-8420
Mailing Address - Fax:
Practice Address - Street 1:716 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-8051
Practice Address - Country:US
Practice Address - Phone:561-385-8420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA604151293101YA0400X
604151293101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA604151293OtherTRIWEST, VETERAN'S ADMINISTRATION
WA604151293OtherVETERAN'S ADMINISTRATION