Provider Demographics
NPI:1609419308
Name:DUKES, DARLENE MARINA
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:MARINA
Last Name:DUKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 S 3430 E
Mailing Address - Street 2:
Mailing Address - City:NEW HARMONY
Mailing Address - State:UT
Mailing Address - Zip Code:84757-5018
Mailing Address - Country:US
Mailing Address - Phone:310-493-2070
Mailing Address - Fax:
Practice Address - Street 1:578 S 3430 E
Practice Address - Street 2:
Practice Address - City:NEW HARMONY
Practice Address - State:UT
Practice Address - Zip Code:84757-5018
Practice Address - Country:US
Practice Address - Phone:310-493-2070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11505797-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health