Healthcare Provider Details

I. General information

NPI: 1750997029
Provider Name (Legal Business Name): NANCY SANDERSON BAKER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10560 MAIN ST STE 518
FAIRFAX VA
22030-7173
US

IV. Provider business mailing address

10560 MAIN ST STE 518
FAIRFAX VA
22030-7173
US

V. Phone/Fax

Practice location:
  • Phone: 703-349-2999
  • Fax:
Mailing address:
  • Phone: 703-334-9299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: