Provider Demographics
NPI:1538558861
Name:DUQUETTE, ALICIA
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:DUQUETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 S CARPENTER AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-5818
Mailing Address - Country:US
Mailing Address - Phone:401-595-6629
Mailing Address - Fax:
Practice Address - Street 1:120 E NEW YORK AVE
Practice Address - Street 2:STE B
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-5568
Practice Address - Country:US
Practice Address - Phone:386-738-5543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH11430101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health