Healthcare Provider Details

I. General information

NPI: 1396152377
Provider Name (Legal Business Name): MOLLY BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 GORDON SMITH DR
MOBILE AL
36617-2319
US

IV. Provider business mailing address

5750A SOUTHLAND DR
MOBILE AL
36693-3316
US

V. Phone/Fax

Practice location:
  • Phone: 251-473-4423
  • Fax:
Mailing address:
  • Phone: 251-473-4423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3622C
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9206
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: