Provider Demographics
NPI:1780226829
Name:BAKER, NICOLE L (LSW, CADC, MHRT/CSP)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:L
Last Name:BAKER
Suffix:
Gender:F
Credentials:LSW, CADC, MHRT/CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 STARKEY RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:CHINA
Mailing Address - State:ME
Mailing Address - Zip Code:04358
Mailing Address - Country:US
Mailing Address - Phone:207-557-2087
Mailing Address - Fax:
Practice Address - Street 1:10 CALDWELL RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5735
Practice Address - Country:US
Practice Address - Phone:207-626-3448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC6889101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)