Provider Demographics
NPI:1740397579
Name:BAUM, VIRGINIA 'GINNY' MARIE (MA LMHC)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA 'GINNY'
Middle Name:MARIE
Last Name:BAUM
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:MS
Other - First Name:VIRGINIA
Other - Middle Name:MARIE
Other - Last Name:CEDERHOLM (MAIDEN NAME)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2396
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248
Mailing Address - Country:US
Mailing Address - Phone:360-224-6590
Mailing Address - Fax:360-383-9063
Practice Address - Street 1:1200 DUPONT ST
Practice Address - Street 2:STE 1-C
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-224-6590
Practice Address - Fax:360-383-9063
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00010830101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH00010830OtherLMHC