Provider Demographics
NPI:1093323982
Name:DUKE, JESSICA MCCONNELL (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MCCONNELL
Last Name:DUKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEIGH
Other - Last Name:MCCONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3860 HEATHER WAY
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-7881
Mailing Address - Country:US
Mailing Address - Phone:229-220-4948
Mailing Address - Fax:
Practice Address - Street 1:3860 HEATHER WAY
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-7881
Practice Address - Country:US
Practice Address - Phone:229-220-4948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0064731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical