Provider Demographics
NPI:1407097132
Name:MCDUFFIE, CLEO K (LCPC, CAC-AD)
Entity Type:Individual
Prefix:MR
First Name:CLEO
Middle Name:K
Last Name:MCDUFFIE
Suffix:
Gender:M
Credentials:LCPC, CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E CHASE ST
Mailing Address - Street 2:SUITE 1116
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2526
Mailing Address - Country:US
Mailing Address - Phone:443-743-3210
Mailing Address - Fax:443-743-3207
Practice Address - Street 1:1 E CHASE ST
Practice Address - Street 2:SUITE 1116
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2526
Practice Address - Country:US
Practice Address - Phone:443-743-3210
Practice Address - Fax:443-743-3207
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC0766101YA0400X
MDLC2676101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)