Provider Demographics
NPI:1629247416
Name:DUVALL, JAMIE F (LCSW, LCAS)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:F
Last Name:DUVALL
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5460 WESLEYAN DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6906
Mailing Address - Country:US
Mailing Address - Phone:757-395-1900
Mailing Address - Fax:
Practice Address - Street 1:5460 WESLEYAN DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6906
Practice Address - Country:US
Practice Address - Phone:757-395-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1414101YA0400X
NCC0058341041C0700X
VA09040097101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106893Medicaid
NCQ39247B145Medicare PIN