Provider Demographics
NPI:1588269831
Name:COX, JACLYN DUVALL (LCSW)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:DUVALL
Last Name:COX
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 1:3932 OBERLIN COURT
Mailing Address - Street 2:NONE
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4510
Mailing Address - Country:US
Mailing Address - Phone:816-589-7628
Mailing Address - Fax:
Practice Address - Street 1:3932 OBERLIN COURT
Practice Address - Street 2:NONE
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4510
Practice Address - Country:US
Practice Address - Phone:816-589-7628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0073721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical