Provider Demographics
NPI:1942620299
Name:DUCKWORTH, ROBERT CHANDLER (LPC (LICENSED PROFES)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CHANDLER
Last Name:DUCKWORTH
Suffix:
Gender:M
Credentials:LPC (LICENSED PROFES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4216 WESLEY STREET
Mailing Address - Street 2:SUITE 700
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401
Mailing Address - Country:US
Mailing Address - Phone:214-912-2551
Mailing Address - Fax:
Practice Address - Street 1:4216 WESLEY STREET
Practice Address - Street 2:SUITE 700
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401
Practice Address - Country:US
Practice Address - Phone:214-912-2551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67909101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional