Healthcare Provider Details

I. General information

NPI: 1508192493
Provider Name (Legal Business Name): BAKER CLINICAL SERVICES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10931 RAVEN RIDGE RD SUITE 109
RALEIGH NC
27614-6499
US

IV. Provider business mailing address

10931 RAVEN RIDGE RD SUITE 109
RALEIGH NC
27614-6499
US

V. Phone/Fax

Practice location:
  • Phone: 919-841-5555
  • Fax: 919-841-5560
Mailing address:
  • Phone: 919-841-5555
  • Fax: 919-841-5560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1836
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC004226
License Number StateNC

VIII. Authorized Official

Name: DR. ANNETTE C. BAKER
Title or Position: PRESIDENT/PSYCHOLOGIST
Credential: PHD
Phone: 919-841-5555