Provider Demographics
NPI:1376795351
Name:DUCKETT, GINA L (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:L
Last Name:DUCKETT
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:L
Other - Last Name:DUCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:5544 HIGHWAY W
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-8779
Mailing Address - Country:US
Mailing Address - Phone:573-776-4475
Mailing Address - Fax:
Practice Address - Street 1:3816 HIGHWAY 67 N
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-8779
Practice Address - Country:US
Practice Address - Phone:573-776-6321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008012586101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional