Provider Demographics
NPI:1083126973
Name:DUCKETT, JAIME (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:JAIME
Middle Name:
Last Name:DUCKETT
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1431
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20604-1431
Mailing Address - Country:US
Mailing Address - Phone:240-598-9888
Mailing Address - Fax:
Practice Address - Street 1:2170 OLD WASHINGTON RD STE 106
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3180
Practice Address - Country:US
Practice Address - Phone:240-598-9888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-31
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD186361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical