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General NPI Number Information
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NPI Number | 1407097132
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Entity Type | Individual
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Provider Name | CLEO K MCDUFFIE LCPC, CAC-AD
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Gender | Male
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Dates
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Enumeration Date | 03/10/2009
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Last Update Date | 07/28/2009
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Provider Practice Location Address
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Address Line | 1 E CHASE ST SUITE 1116
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City | BALTIMORE
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State | MD
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Zip | 21202-2526
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Country | US
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Telephone | 443-743-3210
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Fax | 443-743-3207
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Provider Business Mailing Address
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Address Line | 1 E CHASE ST SUITE 1116
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City | BALTIMORE
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State | MD
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Zip | 21202-2526
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Country | US
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Telephone | 443-743-3210
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Fax | 443-743-3207
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | AC0766
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC2676
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License Number State | MD
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