Basic Information
| Provider Information | |||||||||
| NPI: | 1487648085 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JACOBSON | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3700 JOSEPH SIEWICK DR STE 408A | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220331745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036203211 | ||||||||
| FaxNumber: | 7036203215 | ||||||||
| Practice Location | |||||||||
| Address1: | 3700 JOSEPH SIEWICK DR STE 408A | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220331745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036203211 | ||||||||
| FaxNumber: | 7036203215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2005 | ||||||||
| LastUpdateDate: | 12/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 0701002868 | VA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.