Healthcare Provider Details

I. General information

NPI: 1356972566
Provider Name (Legal Business Name): LAWRENCE VERNON BAKER JR. LPC-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7007 POTSDAM CT
MONTGOMERY AL
36117-8028
US

IV. Provider business mailing address

7007 POTSDAM CT
MONTGOMERY AL
36117-8028
US

V. Phone/Fax

Practice location:
  • Phone: 334-647-1009
  • Fax: 888-856-7677
Mailing address:
  • Phone: 334-647-1009
  • Fax: 888-856-7677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2411
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2411
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: