Provider Demographics
NPI:1689386542
Name:BALDWIN, ALLEIGHA TACHELLE
Entity Type:Individual
Prefix:
First Name:ALLEIGHA
Middle Name:TACHELLE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2452 PHILADELPHUS RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-8302
Mailing Address - Country:US
Mailing Address - Phone:910-748-8112
Mailing Address - Fax:
Practice Address - Street 1:2452 PHILADELPHUS RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-8302
Practice Address - Country:US
Practice Address - Phone:910-748-8112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-21
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)