Provider Demographics
NPI:1639511983
Name:JACOBS, TOVA (PHD)
Entity Type:Individual
Prefix:DR
First Name:TOVA
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 FAIRFAX DR STE 61
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1762
Mailing Address - Country:US
Mailing Address - Phone:937-554-4881
Mailing Address - Fax:
Practice Address - Street 1:3801 FAIRFAX DR STE 61
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1762
Practice Address - Country:US
Practice Address - Phone:703-832-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005197103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical