Individual
DEANA JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC, CCTP
Contact information
Practice address
10203 GLEN CHASE CT, FAIRFAX, VA 22032-3271
(443) 421-6720
Mailing address
10203 GLEN CHASE CT, FAIRFAX, VA 22032-3271
(443) 421-6720
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LC12105
MD
101YM0800X
Mental Health Counselor
LC12105
MD
101YP2500X
Professional Counselor
Primary
LC12105
MD
Other
Enumeration date
12/23/2021
Last updated
12/23/2021
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