MEDICARE: STACIE DUKES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	APC005471	GA

General Provider Information

NPI Number	:	1194373092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACIE DUKES

Provider Business Mailing Address
First Line	:	4194 BURBANK DR APT 108D
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-6202
Country	:	US
Telephone Number	:	678-524-0502
Fax Number	:

Provider Business Practice Location Address
First Line	:	2133 SILVERSIDE DR STE F
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-4179
Country	:	US
Telephone Number	:	225-250-5677
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2019
Last Update Date	:	09/04/2019

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Directions to “ STACIE DUKES ” Practice Location

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