Provider Demographics
NPI:1841798147
Name:JACOBSON-FOWLER, REBECCA (LMT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:JACOBSON-FOWLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2520 DEVENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-2810
Mailing Address - Country:US
Mailing Address - Phone:804-482-1840
Mailing Address - Fax:
Practice Address - Street 1:8720 FOREST HILL AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-2432
Practice Address - Country:US
Practice Address - Phone:804-325-1669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008355101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional