Provider Demographics
NPI:1710396502
Name:BAKER, SUZANNE JANE (MAED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:JANE
Last Name:BAKER
Suffix:
Gender:F
Credentials:MAED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2546 MOUNT TABOR RD
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-8918
Mailing Address - Country:US
Mailing Address - Phone:540-808-8053
Mailing Address - Fax:
Practice Address - Street 1:811 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-5165
Practice Address - Country:US
Practice Address - Phone:540-387-3977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005850101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional