Healthcare Provider Details

I. General information

NPI: 1841759354
Provider Name (Legal Business Name): RUNIQA DARBY BAKER LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 MAGNOLIA ST
HOUMA LA
70360-6304
US

IV. Provider business mailing address

PO BOX 165
HOUMA LA
70361-0165
US

V. Phone/Fax

Practice location:
  • Phone: 985-879-3966
  • Fax: 985-266-8371
Mailing address:
  • Phone: 985-879-3966
  • Fax: 985-266-8371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8098
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: