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NPI 1104364850

NPI 1104364850 : LAUREN SKELTON BAIRD LPC : MABLETON, GA

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General NPI Number Information
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    NPI Number           |    1104364850
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    Entity Type          |    Individual 
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    Provider Name        |    LAUREN SKELTON BAIRD LPC
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    02/02/2017
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    Last Update Date     |    02/02/2017
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Provider Practice Location Address
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    Address Line         |    141 COOPER LAKE RD SE 
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    City                 |    MABLETON
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    State                |    GA
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    Zip                  |    30126-1919
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    Country              |    US
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    Telephone            |    404-519-6561
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    141 COOPER LAKE RD. 
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    City                 |    MABLETON
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    State                |    GA
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    Zip                  |    30126
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    Country              |    US
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    Telephone            |    404-519-6561
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    Fax                  |    
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    101YP2500X
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    Taxonomy Name        |    Professional Counselor
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    License Number       |    LPC007787
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    License Number State |    GA
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