Provider Demographics
NPI:1245401397
Name:BROWN-BAKER, CATREACE S (MA, LPC, LPC/S)
Entity type:Individual
Prefix:MRS
First Name:CATREACE
Middle Name:S
Last Name:BROWN-BAKER
Suffix:
Gender:F
Credentials:MA, LPC, LPC/S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 FAIRFIELD RD
Mailing Address - Street 2:STE B3
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-2575
Mailing Address - Country:US
Mailing Address - Phone:843-379-1003
Mailing Address - Fax:843-379-0700
Practice Address - Street 1:12 FAIRFIELD RD
Practice Address - Street 2:SUITE B3
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907-2575
Practice Address - Country:US
Practice Address - Phone:843-379-1003
Practice Address - Fax:843-379-0700
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5207101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1139Medicaid