Healthcare Provider Details

I. General information

NPI: 1295164879
Provider Name (Legal Business Name): TEENA BAKER LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8390 SIX FORKS RD SUITE 201
RALEIGH NC
27615-3060
US

IV. Provider business mailing address

29 BALSAWOOD CT
WILLOW SPRING NC
27592-7022
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-8730
  • Fax:
Mailing address:
  • Phone: 919-320-5213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA9969
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: