Healthcare Provider Details

I. General information

NPI: 1487809992
Provider Name (Legal Business Name): DAVID CONRAD BAKER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1267 MOUNT OLIVE RD
LOOKOUT MOUNTAIN GA
30750-2930
US

IV. Provider business mailing address

1414 DUG GAP RD
DALTON GA
30720-5007
US

V. Phone/Fax

Practice location:
  • Phone: 706-639-5900
  • Fax:
Mailing address:
  • Phone: 706-279-0405
  • Fax: 706-279-4190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC006479
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: