Healthcare Provider Details

I. General information

NPI: 1275913618
Provider Name (Legal Business Name): MRS. CHRISTINE YOUNG BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINE YOUNG BAKER

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20871 JOHNSON ST STE 105
PEMBROKE PINES FL
33029-1918
US

IV. Provider business mailing address

20871 JOHNSON ST STE 105
PEMBROKE PINES FL
33029-1918
US

V. Phone/Fax

Practice location:
  • Phone: 954-843-0273
  • Fax: 954-404-6198
Mailing address:
  • Phone: 954-593-4097
  • Fax: 954-404-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMCAP.0101261
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 13390
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberMH13390
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCBHCMS101102
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: