Provider Demographics
NPI:1124489612
Name:DOUCETTE, JENNIFER MARGARET (BA, MA, CADC I, QMHP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MARGARET
Last Name:DOUCETTE
Suffix:
Gender:F
Credentials:BA, MA, CADC I, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 SW WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2328
Mailing Address - Country:US
Mailing Address - Phone:503-535-1171
Mailing Address - Fax:
Practice Address - Street 1:1321 SW WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2328
Practice Address - Country:US
Practice Address - Phone:503-535-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health