Provider Demographics
NPI:1164074027
Name:BAKER, ANITA (BS, SWT)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:BS, SWT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-3112
Mailing Address - Country:US
Mailing Address - Phone:313-921-9422
Mailing Address - Fax:313-571-9022
Practice Address - Street 1:10100 HARPER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-3112
Practice Address - Country:US
Practice Address - Phone:313-921-9422
Practice Address - Fax:313-571-9022
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803086976101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor