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General NPI Number Information
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NPI Number | 1659586071
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Entity Type | Organization
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Legal Business Name | SALLY A. BAKER, LCSW, P.C.
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2940 N LYNNHAVEN RD SUITE 110
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-6949
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Country | US
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Telephone | 757-287-3048
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Fax |
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Provider Business Mailing Address
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Address Line | 2940 N LYNNHAVEN RD SUITE 110
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-6949
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SALLY BAKER
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Credential | LCSW
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Telephone | 757-287-3048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0904 000019
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License Number State | VA
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