Healthcare Provider Details

I. General information

NPI: 1245058668
Provider Name (Legal Business Name): MICHELLE A BAKER LCPC-CC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 S MERRILL LN
HARTFORD ME
04220-5643
US

IV. Provider business mailing address

5 S MERRILL LN
HARTFORD ME
04220-5643
US

V. Phone/Fax

Practice location:
  • Phone: 207-807-2112
  • Fax:
Mailing address:
  • Phone: 207-807-2112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC9231
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberXL7575
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: