Healthcare Provider Details

I. General information

NPI: 1356923619
Provider Name (Legal Business Name): SAMANTHA BAKER CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 DELAWARE AVE STE A
MARION OH
43302-6461
US

IV. Provider business mailing address

3433 AGLER RD STE 2100
COLUMBUS OH
43219-3389
US

V. Phone/Fax

Practice location:
  • Phone: 614-599-6869
  • Fax: 614-413-3464
Mailing address:
  • Phone: 614-599-6869
  • Fax: 614-413-3464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.176204
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: