Provider Demographics
NPI:1497722789
Name:JACOBS, HARVEY EARL (PHD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:EARL
Last Name:JACOBS
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 1:3990 REEDS LANDING CIR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-1385
Mailing Address - Country:US
Mailing Address - Phone:804-814-0609
Mailing Address - Fax:
Practice Address - Street 1:7400 BEAUFONT SPRINGS DR
Practice Address - Street 2:SUITE 401
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225-5556
Practice Address - Country:US
Practice Address - Phone:804-323-5560
Practice Address - Fax:804-323-5562
Is Sole Proprietor?:No
Enumeration Date:2006-03-05
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3198103T00000X
VA0810-002607103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010116261Medicaid
VA010139759Medicaid