Healthcare Provider Details

I. General information

NPI: 1396757548
Provider Name (Legal Business Name): MICHELE L BALDWIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6515 GEORGE WASHINGTON MEM HWY STE 100
GRAFTON VA
23692-2182
US

IV. Provider business mailing address

PO BOX 1069
GRAFTON VA
23692-1069
US

V. Phone/Fax

Practice location:
  • Phone: 757-877-9140
  • Fax: 757-877-3925
Mailing address:
  • Phone: 757-877-9140
  • Fax: 757-877-3925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0904001919
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: