Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003468810 |
---|---|
Provider Name | Mr. Delroy A Duckworth |
First Address | Anchorage, AK 99501-4664 |
Second Address | Anchorage, AK 99501-4664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2019 |
Last Update Date | 11/07/2019 |