Provider Demographics
NPI:1366095994
Name:SCHMITZ, JACOB CHARLES SHOWALTER (PSYD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:CHARLES SHOWALTER
Last Name:SCHMITZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520B MAYLAND CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1421
Mailing Address - Country:US
Mailing Address - Phone:804-404-3735
Mailing Address - Fax:
Practice Address - Street 1:3520B MAYLAND CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1421
Practice Address - Country:US
Practice Address - Phone:804-404-3735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810006259103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical