Provider Demographics
NPI:1942256011
Name:BAKER-CRELLIN, NANCY E (ACSW, LCSW, CSAC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:E
Last Name:BAKER-CRELLIN
Suffix:
Gender:F
Credentials:ACSW, LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 KILSON DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8162
Mailing Address - Country:US
Mailing Address - Phone:704-660-8321
Mailing Address - Fax:704-660-8323
Practice Address - Street 1:107 KILSON DR
Practice Address - Street 2:SUITE 202
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8162
Practice Address - Country:US
Practice Address - Phone:704-660-8321
Practice Address - Fax:704-660-8323
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007101YA0400X
NCC0051611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)