Provider Demographics
NPI:1437272408
Name:BAKER, CARRIE LILLIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:LILLIE
Last Name:BAKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 LETHBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-4609
Mailing Address - Country:US
Mailing Address - Phone:919-851-5618
Mailing Address - Fax:919-233-4729
Practice Address - Street 1:144 ANNARON CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-3640
Practice Address - Country:US
Practice Address - Phone:919-851-5618
Practice Address - Fax:919-233-4729
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1572103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000894Medicaid
NC0320MOtherBCBS