Provider Demographics
NPI:1386389880
Name:DUKES, DAISJA D'ATRA (LPC, CPCS)
Entity type:Individual
Prefix:
First Name:DAISJA
Middle Name:D'ATRA
Last Name:DUKES
Suffix:
Gender:F
Credentials:LPC, CPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6887 GALLIER ST
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-7054
Mailing Address - Country:US
Mailing Address - Phone:478-952-3555
Mailing Address - Fax:
Practice Address - Street 1:6887 GALLIER ST
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-7054
Practice Address - Country:US
Practice Address - Phone:478-952-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010664101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional