Individual
DR. JACOB LANDON DEBOER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD, NCSP, LCP
Contact information
Practice address
13900 HULL STREET RD, MIDLOTHIAN, VA 23112-2004
(804) 639-8900
Mailing address
13900 HULL STREET RD, MIDLOTHIAN, VA 23112-2004
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810008680
VA
103TS0200X
School Psychologist
PPS-0607703
VA
Other
Enumeration date
05/10/2021
Last updated
10/03/2024
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