Provider Information for 1578101523
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MICHELLE DURHAM LPC
Sex: Female
NPI: 1578101523
Last Updated: 2019-12-19
Certification Date: 2019-12-19
Certification Date: 2019-12-19
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1578101523 | ||||||||
| Enumeration Date | 2019-12-19 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 12504 KEYNOTE LN BOWIE, MD 20715-2746 United States Phone: 301-520-9764 | Fax: | ||||||||
| Primary Practice Address | 12504 KEYNOTE LN BOWIE, MD 20715-2746 United States Phone: 301-520-9764 | Fax: | ||||||||
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