Individual
JEFFREY MARK DUCKWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
377 BLACKGUM TRCE, DALLAS, GA 30132-5563
(770) 757-2716
Mailing address
377 BLACKGUM TRCE, DALLAS, GA 30132-5563
(770) 757-2716
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
007902
GA
1041C0700X
Clinical Social Worker
Primary
CSW007902
GA
Other
Enumeration date
12/06/2023
Last updated
08/23/2024
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