Provider Demographics
NPI:1043483472
Name:DUKES, PAMELA RENEE (MHS, CAC-AD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:RENEE
Last Name:DUKES
Suffix:
Gender:F
Credentials:MHS, 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:PO BOX 2727
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21225-0727
Mailing Address - Country:US
Mailing Address - Phone:443-831-0191
Mailing Address - Fax:410-355-2350
Practice Address - Street 1:1002 E PATAPSCO AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-2229
Practice Address - Country:US
Practice Address - Phone:443-831-0191
Practice Address - Fax:410-355-3971
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YA0400X
101YA0400X
AC0806101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)