Provider Demographics
NPI:1457820284
Name:JACOUB, SYLVIA (PSYD)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:JACOUB
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SYLVIA
Other - Middle Name:
Other - Last Name:HANNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:10301 DEMOCRACY LN STE 201
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2545
Mailing Address - Country:US
Mailing Address - Phone:703-349-5560
Mailing Address - Fax:
Practice Address - Street 1:10301 DEMOCRACY LN STE 201
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2545
Practice Address - Country:US
Practice Address - Phone:703-547-3509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004835103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical