Provider Demographics
NPI:1336844109
Name:BRATCHER, JACOB DYLAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:DYLAN
Last Name:BRATCHER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5296 PETERS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-3808
Mailing Address - Country:US
Mailing Address - Phone:540-215-0535
Mailing Address - Fax:540-206-2109
Practice Address - Street 1:5296 PETERS CREEK RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-3808
Practice Address - Country:US
Practice Address - Phone:540-359-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040150971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical