Provider Demographics
NPI:1598210882
Name:BAKER, ALVIN JR
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:
Last Name:BAKER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 29TH AVE
Mailing Address - Street 2:STE 36
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2843
Mailing Address - Country:US
Mailing Address - Phone:228-865-4500
Mailing Address - Fax:
Practice Address - Street 1:730 E BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-6259
Practice Address - Country:US
Practice Address - Phone:228-865-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC88881041C0700X
MSM88881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical