Provider Demographics
NPI:1407565864
Name:SEARS, JACOB (LGPC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:SEARS
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1774 ABERDEEN CIR
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1638
Mailing Address - Country:US
Mailing Address - Phone:315-403-0109
Mailing Address - Fax:
Practice Address - Street 1:1774 ABERDEEN CIR
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1638
Practice Address - Country:US
Practice Address - Phone:315-403-0109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13219101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional