Healthcare Provider Details

I. General information

NPI: 1659884625
Provider Name (Legal Business Name): JAQUELLA DUNCAN LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date: 12/19/2021
Reactivation Date: 08/14/2023

III. Provider practice location address

4530 WISCONSIN AVE NW STE 300
WASHINGTON DC
20016-4606
US

IV. Provider business mailing address

4530 WISCONSIN AVE NW STE 300
WASHINGTON DC
20016-4606
US

V. Phone/Fax

Practice location:
  • Phone: 202-536-4414
  • Fax: 703-483-9928
Mailing address:
  • Phone: 202-536-4414
  • Fax: 703-483-9928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLG200004295
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: