Individual
JACOB WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1130 TABB ST, NORFOLK, VA 23504-3434
(804) 921-2389
Mailing address
1130 TABB ST, NORFOLK, VA 23504-3434
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/30/2019
Last updated
05/30/2019
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