Provider Demographics
NPI:1497974224
Name:JEAN-JACQUES, DULCIE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:DULCIE
Middle Name:
Last Name:JEAN-JACQUES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2292 LAZY DAYS RD
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-6676
Mailing Address - Country:US
Mailing Address - Phone:678-698-4072
Mailing Address - Fax:678-482-2069
Practice Address - Street 1:2292 LAZY DAYS RD
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-6676
Practice Address - Country:US
Practice Address - Phone:678-698-4072
Practice Address - Fax:678-482-2069
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00077159AMedicaid