Provider Demographics
NPI:1811759137
Name:MCDUFFIE, JEROME REUBEN JR (LMHC)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:REUBEN
Last Name:MCDUFFIE
Suffix:JR
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 S ATLANTIC AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:32118-5037
Mailing Address - Country:US
Mailing Address - Phone:985-277-1023
Mailing Address - Fax:
Practice Address - Street 1:429 N RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-3250
Practice Address - Country:US
Practice Address - Phone:985-277-1023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22977101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health