Provider Demographics
NPI:1437183860
Name:DOUCETTE, JEANNE F (LCSW)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:F
Last Name:DOUCETTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 W 21ST ST STE 205
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-2130
Mailing Address - Country:US
Mailing Address - Phone:757-622-9852
Mailing Address - Fax:757-622-4033
Practice Address - Street 1:327 W 21ST ST STE 205
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-2130
Practice Address - Country:US
Practice Address - Phone:757-622-9852
Practice Address - Fax:757-622-4033
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904000321101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8905169Medicaid
VA8905169Medicaid
VA009137T23Medicare ID - Type Unspecified