Healthcare Provider Details

I. General information

NPI: 1770825721
Provider Name (Legal Business Name): BROOKE RENEE BAKER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2013
Last Update Date: 03/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 K ST NW STE 300
WASHINGTON DC
20006-1631
US

IV. Provider business mailing address

8401 MANCHESTER RD APT 701
SILVER SPRING MD
20901-6040
US

V. Phone/Fax

Practice location:
  • Phone: 240-292-9323
  • Fax:
Mailing address:
  • Phone: 240-750-7295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPRC14335
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: