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General NPI Number Information
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NPI Number | 1932072857
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Entity Type | Individual
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Provider Name | SELENA BAKER
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Gender | Female
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Dates
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Enumeration Date | 09/26/2025
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 1832 KEMPSVILLE ROAD STE 112 #409
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464
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Country | US
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Telephone | 757-472-7721
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 62036
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City | VIRGINIA BEACH
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State | VA
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Zip | 23466-2036
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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 |
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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 | 0701015305
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License Number State | VA
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