Provider Demographics
NPI:1669448296
Name:BAKER, MELISSA DENISE (LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:DENISE
Last Name:BAKER
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 YORK AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-2355
Mailing Address - Country:US
Mailing Address - Phone:336-880-8198
Mailing Address - Fax:
Practice Address - Street 1:1623 YORK AVE STE 107
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-2355
Practice Address - Country:US
Practice Address - Phone:336-884-8658
Practice Address - Fax:336-884-0920
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3681101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102983Medicaid