Provider Demographics
NPI:1740918804
Name:ORR, JACOB TIMOTHY (LCMHC)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:TIMOTHY
Last Name:ORR
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 BROOKS BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:NC
Mailing Address - Zip Code:28748-7404
Mailing Address - Country:US
Mailing Address - Phone:828-620-5747
Mailing Address - Fax:
Practice Address - Street 1:28 BROOKS BRANCH RD
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:NC
Practice Address - Zip Code:28748-7404
Practice Address - Country:US
Practice Address - Phone:828-620-5747
Practice Address - Fax:828-484-1025
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17656101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health