Healthcare Provider Details

I. General information

NPI: 1437183860
Provider Name (Legal Business Name): JEANNE F. DOUCETTE L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 W 21ST ST STE 205
NORFOLK VA
23517-2130
US

IV. Provider business mailing address

327 W 21ST ST STE 205
NORFOLK VA
23517-2130
US

V. Phone/Fax

Practice location:
  • Phone: 757-622-9852
  • Fax: 757-622-4033
Mailing address:
  • Phone: 757-622-9852
  • Fax: 757-622-4033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0904000321
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: