Provider Demographics
NPI:1710203625
Name:JORGENSEN, ANNIE DUVIC (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANNIE
Middle Name:DUVIC
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:DUVIC
Other - Last Name:WALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1341 W MOCKINGBIRD LN STE 500E
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4937
Mailing Address - Country:US
Mailing Address - Phone:214-456-8980
Mailing Address - Fax:214-456-8081
Practice Address - Street 1:1341 W MOCKINGBIRD LN STE 500E
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4937
Practice Address - Country:US
Practice Address - Phone:214-456-8980
Practice Address - Fax:214-456-8081
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX504451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical