Healthcare Provider Details

I. General information

NPI: 1629429006
Provider Name (Legal Business Name): MARIAN STUKES LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 YORK RD SUITE 201
BALTIMORE MD
21212-3610
US

IV. Provider business mailing address

5820 YORK RD SUITE 201
BALTIMORE MD
21212-3610
US

V. Phone/Fax

Practice location:
  • Phone: 410-800-2169
  • Fax: 410-777-8742
Mailing address:
  • Phone: 410-800-2169
  • Fax: 410-777-8742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC6297
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: