Provider Demographics
NPI:1114145919
Name:BALTIMORE, VELMA LOUISE (PHD)
Entity Type:Individual
Prefix:
First Name:VELMA
Middle Name:LOUISE
Last Name:BALTIMORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:VELMA
Other - Middle Name:LOUISE
Other - Last Name:BALTIMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2106 BROWN STREET
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204
Mailing Address - Country:US
Mailing Address - Phone:501-663-1873
Mailing Address - Fax:
Practice Address - Street 1:2106 BROWN ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-4158
Practice Address - Country:US
Practice Address - Phone:501-663-1873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP8102106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist