Healthcare Provider Details

I. General information

NPI: 1700959095
Provider Name (Legal Business Name): ARTHUR ODEAN BAKER II LPC LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 GREAT BRIDGE BLVD. CITY OF CHESAPEAKE TA CHESAPEAKE COMMUNITY SRVCS BRD
CHESAPEAKE VA
23320
US

IV. Provider business mailing address

224 GREAT BRIDGE BLVD. CITY OF CHESAPEAKE TA CHESAPEAKE COMMUNITY SRVCS BRD
CHESAPEAKE VA
23320
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-9334
  • Fax: 757-819-6292
Mailing address:
  • Phone: 757-547-9334
  • Fax: 757-819-6292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701002183
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: