Active NPI
Theresa Jacob, LPC
- Professional Counselor
- Herndon, VA
National Provider Identifier
1215097944
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 0701002593
- Practice address
- 297 Herndon Pkwy
Ste. 202
Herndon, VA 20170-4474 - Phone
- (703) 481-6130
- NPI assigned
- Dec 11, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 0701002593 | VA | Primary |
Addresses
Primary practice location
297 Herndon Pkwy
Ste. 202
Herndon, VA 20170-4474
Mailing address
297 Herndon Pkwy
Ste. 202
Herndon, VA 20170-4474
Phone (703) 481-6130
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 15, 2024 through Nov 15, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0701002593 | VA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1215097944",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "297 HERNDON PKWY",
"address_2": "STE. 202",
"city": "HERNDON",
"state": "VA",
"postal_code": "201704474",
"telephone_number": "703-481-6130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "297 HERNDON PKWY",
"address_2": "STE. 202",
"city": "HERNDON",
"state": "VA",
"postal_code": "201704474",
"telephone_number": "703-481-6130"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOB",
"first_name": "THERESA",
"name_prefix": "Ms.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "VA",
"license": "0701002593",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Herndon, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.