Provider Demographics
NPI:1760510580
Name:JAMES F JACOBS, PH.D., LMFT
Entity Type:Organization
Organization Name:JAMES F JACOBS, PH.D., LMFT
Other - Org Name:JAMES F. JACOBS, PH.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:804-586-7017
Mailing Address - Street 1:10807 STERLING COVE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-5247
Mailing Address - Country:US
Mailing Address - Phone:804-586-7017
Mailing Address - Fax:804-748-9517
Practice Address - Street 1:211 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2509
Practice Address - Country:US
Practice Address - Phone:804-586-7017
Practice Address - Fax:804-458-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2015-10-30
Deactivation Date:2008-07-11
Deactivation Code:
Reactivation Date:2015-10-30
Provider Licenses
StateLicense IDTaxonomies
TX14421101YP2500X
VA017000722106H00000X
WALF00000856106H00000X
TX004765106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010355044Medicaid