Provider Demographics
NPI:1578101523
Name:DURHAM, MICHELLE (LPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:DURHAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12504 KEYNOTE LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-2746
Mailing Address - Country:US
Mailing Address - Phone:301-520-9764
Mailing Address - Fax:
Practice Address - Street 1:12504 KEYNOTE LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-2746
Practice Address - Country:US
Practice Address - Phone:301-520-9764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14964101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional