Provider Demographics
NPI:1033862503
Name:BAKER, SAMUEL DIXON (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:DIXON
Last Name:BAKER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 NORTH AVE NE APT 3206
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2459
Mailing Address - Country:US
Mailing Address - Phone:812-457-0543
Mailing Address - Fax:
Practice Address - Street 1:215 NORTH AVE NE APT 3206
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2459
Practice Address - Country:US
Practice Address - Phone:812-457-0543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0072371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical