Provider Demographics
NPI:1215514708
Name:DUFFY, JILL SECREAST (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:SECREAST
Last Name:DUFFY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6072 POWDER POINT DR
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-9412
Mailing Address - Country:US
Mailing Address - Phone:828-270-5408
Mailing Address - Fax:
Practice Address - Street 1:6072 POWDER POINT DR
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-9412
Practice Address - Country:US
Practice Address - Phone:828-855-0425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC005761101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health