Provider Demographics
NPI:1194819037
Name:BAKER, HEATHER NELSON (LCSW, CEDS)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:NELSON
Last Name:BAKER
Suffix:
Gender:F
Credentials:LCSW, CEDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 STERLING RD STE 230
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-3865
Mailing Address - Country:US
Mailing Address - Phone:703-466-5150
Mailing Address - Fax:703-649-3557
Practice Address - Street 1:1031 STERLING RD STE 230
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-3865
Practice Address - Country:US
Practice Address - Phone:703-466-5150
Practice Address - Fax:703-649-3557
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040054191041C0700X
261QM0855X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health