Provider Demographics
NPI:1437813763
Name:DUKE, JENNY A (LAC)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:A
Last Name:DUKE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 MCCAIN BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-8057
Mailing Address - Country:US
Mailing Address - Phone:501-812-4268
Mailing Address - Fax:501-812-4286
Practice Address - Street 1:4004 MCCAIN BLVD STE 203
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-8057
Practice Address - Country:US
Practice Address - Phone:501-812-4268
Practice Address - Fax:501-812-4286
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2108028101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health