Provider Demographics
NPI:1467188672
Name:BAUM, JACOB CHRISTOPHER (LCMHCA)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:CHRISTOPHER
Last Name:BAUM
Suffix:
Gender:M
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11314 PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-4681
Mailing Address - Country:US
Mailing Address - Phone:704-771-8541
Mailing Address - Fax:
Practice Address - Street 1:11314 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-4681
Practice Address - Country:US
Practice Address - Phone:704-771-8541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17560101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional