Provider Demographics
NPI:1447884416
Name:DURRETT, JAY MARIE (LCPC)
Entity type:Individual
Prefix:MRS
First Name:JAY
Middle Name:MARIE
Last Name:DURRETT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:872 BIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21915-1029
Mailing Address - Country:US
Mailing Address - Phone:443-566-2237
Mailing Address - Fax:
Practice Address - Street 1:102 OLD MILL PLZ
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901-3927
Practice Address - Country:US
Practice Address - Phone:410-287-6569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC13168101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health