Healthcare Provider Details

I. General information

NPI: 1558005975
Provider Name (Legal Business Name): PAMELA NICOLE DUKES LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8058 S WESTERN AVE
CHICAGO IL
60620-5936
US

IV. Provider business mailing address

8058 S WESTERN AVE
CHICAGO IL
60620-5936
US

V. Phone/Fax

Practice location:
  • Phone: 773-306-1773
  • Fax:
Mailing address:
  • Phone: 773-306-1773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180.016739
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.016739
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.016739
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: