Organization
JACOB CLARK PSYCHOTHERAPY GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES JACOB CLARK LPC (PRESIDENT/PRACTICE OWNER)
(571) 206-8137
Entity
Organization
Contact information
Practice address
12351 DUTTON RD APT 1418, MIDLOTHIAN, VA 23113-4415
(571) 206-8137
Mailing address
14319 SHELTER COVE RD, MIDLOTHIAN, VA 23112-2240
(571) 206-8137
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0022808
LPC
CO
01
—
1487389250
LICENSE
VA
Enumeration date
09/09/2025
Last updated
09/09/2025
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