Provider Demographics
NPI:1750639274
Name:BAKER, JENSON LIONEL (MS, QMHP)
Entity Type:Individual
Prefix:MR
First Name:JENSON
Middle Name:LIONEL
Last Name:BAKER
Suffix:
Gender:M
Credentials:MS, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 CHANDLER HARPER DR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-2108
Mailing Address - Country:US
Mailing Address - Phone:757-817-6535
Mailing Address - Fax:757-484-1553
Practice Address - Street 1:3801 KING STREET
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-2370
Practice Address - Country:US
Practice Address - Phone:757-673-2950
Practice Address - Fax:757-673-2951
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1765101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health