Provider Demographics
NPI:1760125306
Name:DUSTER, JENNIFER COOK (LICSW, PIP, LLC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:COOK
Last Name:DUSTER
Suffix:
Gender:F
Credentials:LICSW, PIP, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 PAINTROCK ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:AL
Mailing Address - Zip Code:35760
Mailing Address - Country:US
Mailing Address - Phone:256-577-7754
Mailing Address - Fax:
Practice Address - Street 1:44 HUGHES RD STE 1050
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-3046
Practice Address - Country:US
Practice Address - Phone:256-631-7898
Practice Address - Fax:256-542-3366
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1623-4181C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical