Provider Demographics
NPI:1407394497
Name:BAKER-HUTCHINSON, JODI SHANI (LCSW)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:SHANI
Last Name:BAKER-HUTCHINSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 WHISPER WALK
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-6019
Mailing Address - Country:US
Mailing Address - Phone:757-478-4043
Mailing Address - Fax:
Practice Address - Street 1:930 REDGATE AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1518
Practice Address - Country:US
Practice Address - Phone:757-626-3733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040097681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical