Provider Demographics
NPI:1679876247
Name:DUHART, LORI ELLEN (NCC, LPC)
Entity type:Individual
Prefix:MISS
First Name:LORI
Middle Name:ELLEN
Last Name:DUHART
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 DENTON ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-1614
Mailing Address - Country:US
Mailing Address - Phone:919-638-0730
Mailing Address - Fax:
Practice Address - Street 1:431 DENTON ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-1614
Practice Address - Country:US
Practice Address - Phone:919-638-0730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8325101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104669Medicaid