Provider Demographics
NPI:1184050213
Name:WARD-BAKER, JACQUELINE LEIGH (LCPC)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:LEIGH
Last Name:WARD-BAKER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5061 COOPER RD
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:MD
Mailing Address - Zip Code:21822-2155
Mailing Address - Country:US
Mailing Address - Phone:410-713-4058
Mailing Address - Fax:
Practice Address - Street 1:201 PINE BLUFF RD STE 2
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7163
Practice Address - Country:US
Practice Address - Phone:410-713-4058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5298101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional