Healthcare Provider Details

I. General information

NPI: 1235987389
Provider Name (Legal Business Name): KIMBERLY L BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5107 PARRISH CREEK TER
CHESTERFIELD VA
23832-4070
US

IV. Provider business mailing address

585 GROVE ST STE 145NO500
HERNDON VA
20170-4726
US

V. Phone/Fax

Practice location:
  • Phone: 919-906-6048
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701016467
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: