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General NPI Number Information
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NPI Number | 1487983367
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Entity Type | Individual
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Provider Name | CONNIE DENNISE BALDWIN MS, LMHC(FL),LPC(TX)
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Gender | Female
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Dates
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Enumeration Date | 12/23/2009
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Last Update Date | 04/23/2018
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Provider Practice Location Address
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Address Line | 3922 JACE DR
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City | CRESTVIEW
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State | FL
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Zip | 32539-6510
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Country | US
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Telephone | 210-885-5963
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Fax |
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Provider Business Mailing Address
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Address Line | 405 OLDE POST RD
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City | NICEVILLE
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State | FL
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Zip | 32578-3905
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Country | US
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Telephone | 210-885-5963
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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 | 63853
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 10460723-6004
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | MH5223
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License Number State | FL
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