Provider Demographics
NPI:1962649970
Name:BAKER, WILLIAM M (PHD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:BAKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-2105
Mailing Address - Country:US
Mailing Address - Phone:864-237-4901
Mailing Address - Fax:864-542-2324
Practice Address - Street 1:601 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-2105
Practice Address - Country:US
Practice Address - Phone:864-237-4901
Practice Address - Fax:864-542-2324
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC326103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist