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General NPI Number Information
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NPI Number | 1750639274
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Entity Type | Individual
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Provider Name | JENSON LIONEL BAKER MS, QMHP
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Gender | Male
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 07/08/2019
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Provider Practice Location Address
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Address Line | 3801 KING STREET
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City | PORTSMOUTH
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State | VA
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Zip | 23707-2370
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Country | US
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Telephone | 757-673-2950
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Fax | 757-673-2951
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Provider Business Mailing Address
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Address Line | 504 CHANDLER HARPER DR
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City | PORTSMOUTH
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State | VA
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Zip | 23701-2108
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Country | US
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Telephone | 757-817-6535
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Fax | 757-484-1553
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1765
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License Number State | VA
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