Healthcare Provider Details

I. General information

NPI: 1679314892
Provider Name (Legal Business Name): GEORGIA ANNE BALDWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 HARRISON ST
SAN FRANCISCO CA
94107-1235
US

IV. Provider business mailing address

760 HARRISON ST
SAN FRANCISCO CA
94107-1235
US

V. Phone/Fax

Practice location:
  • Phone: 707-469-4620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC20473
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: