MEDICARE: STEPHANIE BAKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701013648	VA

General Provider Information

NPI Number	:	1649003880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE BAKER

Provider Business Mailing Address
First Line	:	611 SECOND AVE
Second Line	:
City	:	FARMVILLE
State	:	VA
Zip	:	23901-2007
Country	:	US
Telephone Number	:	434-390-1597
Fax Number	:

Provider Business Practice Location Address
First Line	:	16035 CONTINENTAL BLVD
Second Line	:
City	:	SOUTH CHESTERFIELD
State	:	VA
Zip	:	23834-5900
Country	:	US
Telephone Number	:	434-390-1597
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2024
Last Update Date	:	11/12/2024

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Directions to “ STEPHANIE BAKER ” Practice Location

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