Healthcare Provider Details

I. General information

NPI: 1265044416
Provider Name (Legal Business Name): KAREN REBECCA BAUGH-JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 DOGWOOD LN
ORANGE VA
22960-1058
US

IV. Provider business mailing address

428 WALDROP RD
GORDONSVILLE VA
22942-6201
US

V. Phone/Fax

Practice location:
  • Phone: 888-365-6271
  • Fax:
Mailing address:
  • Phone: 720-360-5522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904007325
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: