Provider Demographics
NPI:1982832135
Name:DOUTE, JEMAL (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JEMAL
Middle Name:
Last Name:DOUTE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-0312
Mailing Address - Country:US
Mailing Address - Phone:678-489-7384
Mailing Address - Fax:866-311-8215
Practice Address - Street 1:500 LANIER AVE W STE 508
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7637
Practice Address - Country:US
Practice Address - Phone:678-489-7384
Practice Address - Fax:866-311-8215
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001277106H00000X
NY000734-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist