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Individual

MR. JACOB M BOUNDS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MSW, LGSW

Contact information

Practice address
1109 JEFFERSON RD STE C, SOUTH CHARLESTON, WV 25309-8815
(877) 338-2725
Mailing address
1234 STONE RD APT A, CHARLESTON, WV 25314-1881
(304) 989-1290

Taxonomy

Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
1041C0700X
Clinical Social Worker
Primary
BP00945821
WV
1041C0700X
Clinical Social Worker
SW062015550
WV

Other

Enumeration date
10/30/2020
Last updated
02/01/2021
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