Provider Demographics
NPI:1508240003
Name:BAKER, TONEISHA SHERRELL (LCSW)
Entity Type:Individual
Prefix:
First Name:TONEISHA
Middle Name:SHERRELL
Last Name:BAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TONEISHA
Other - Middle Name:SHERRELL
Other - Last Name:NIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1815 PLEASANT GROVE ROAD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404
Mailing Address - Country:US
Mailing Address - Phone:870-933-6886
Mailing Address - Fax:870-933-9395
Practice Address - Street 1:2126 N. 1ST STREET SUITE F
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076
Practice Address - Country:US
Practice Address - Phone:501-982-5000
Practice Address - Fax:501-982-5007
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX541911041C0700X
AR8540-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical