Provider Demographics
NPI:1578002101
Name:GOLDSHTEYN, JACOB LEONIDOVICH (LPC)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:LEONIDOVICH
Last Name:GOLDSHTEYN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2877 NORTHVIEW DR SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-3933
Mailing Address - Country:US
Mailing Address - Phone:540-798-5222
Mailing Address - Fax:
Practice Address - Street 1:3635 MANASSAS DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4031
Practice Address - Country:US
Practice Address - Phone:540-774-4686
Practice Address - Fax:540-989-8893
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006983101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional