Basic Information
| Provider Information | |||||||||
| NPI: | 1740675537 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DURANT | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 219 W PATRICK ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217016933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016623223 | ||||||||
| FaxNumber: | 3016627921 | ||||||||
| Practice Location | |||||||||
| Address1: | 219 W PATRICK ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217016933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016623223 | ||||||||
| FaxNumber: | 3016627921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2015 | ||||||||
| LastUpdateDate: | 03/30/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LC6035 | MD | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.