Provider Demographics
NPI:1659884625
Name:DUNCAN, JAQUELLA (CACLL)
Entity Type:Individual
Prefix:MS
First Name:JAQUELLA
Middle Name:
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:CACLL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 PENNSYLVANIA AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2167
Mailing Address - Country:US
Mailing Address - Phone:202-804-6175
Mailing Address - Fax:
Practice Address - Street 1:4664 G ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-7835
Practice Address - Country:US
Practice Address - Phone:240-534-8149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-13
Last Update Date:2023-08-16
Deactivation Date:2021-12-19
Deactivation Code:
Reactivation Date:2023-08-14
Provider Licenses
StateLicense IDTaxonomies
DC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC$$$$$$$$$Medicaid