Provider Demographics
NPI:1467048637
Name:BAKER, LAKETIA DESHAWN (LCSW)
Entity Type:Individual
Prefix:
First Name:LAKETIA
Middle Name:DESHAWN
Last Name:BAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAKETIA
Other - Middle Name:DESHAWN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:10221 KRAUSE RD UNIT 624
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-1225
Mailing Address - Country:US
Mailing Address - Phone:804-496-1073
Mailing Address - Fax:
Practice Address - Street 1:6419 FAULKNER DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-6213
Practice Address - Country:US
Practice Address - Phone:804-599-0705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ5-00000571041C0700X
VA09040149201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical