Provider Demographics
NPI:1558472985
Name:JACOBS, DEBORAH (MSW)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 WOODBURN RD
Mailing Address - Street 2:WOODBURN CENTER
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1202
Mailing Address - Country:US
Mailing Address - Phone:703-573-0523
Mailing Address - Fax:703-280-9518
Practice Address - Street 1:3340 WOODBURN RD
Practice Address - Street 2:WOODBURN CENTER
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1202
Practice Address - Country:US
Practice Address - Phone:703-573-0523
Practice Address - Fax:703-280-9518
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040024621041C0700X
DCLICSW 3033321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical