Provider Demographics
NPI:1073986337
Name:BAKER, DIANNA
Entity Type:Individual
Prefix:MS
First Name:DIANNA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 COLLEGE AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:GRAMBLING
Mailing Address - State:LA
Mailing Address - Zip Code:71245-2445
Mailing Address - Country:US
Mailing Address - Phone:916-420-4898
Mailing Address - Fax:
Practice Address - Street 1:829 E GEORGIA AVE STE 3
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3901
Practice Address - Country:US
Practice Address - Phone:318-242-0750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health