Provider Demographics
NPI:1376128223
Name:BAKER-MECKLEY, BRYANNA LEA (LGSW)
Entity Type:Individual
Prefix:
First Name:BRYANNA
Middle Name:LEA
Last Name:BAKER-MECKLEY
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:BRYANNA
Other - Middle Name:LEA
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW
Mailing Address - Street 1:131 WELLNESS DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-5402
Mailing Address - Country:US
Mailing Address - Phone:304-872-6503
Mailing Address - Fax:304-872-5415
Practice Address - Street 1:131 WELLNESS DR
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-5402
Practice Address - Country:US
Practice Address - Phone:304-872-2659
Practice Address - Fax:304-872-1685
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP009458261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical