Provider Demographics
NPI:1245530120
Name:BAKER COUNSELING RESOURCES, LLC
Entity type:Organization
Organization Name:BAKER COUNSELING RESOURCES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:CAROL BAAS
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-882-2227
Mailing Address - Street 1:PO BOX 2089
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-0036
Mailing Address - Country:US
Mailing Address - Phone:678-882-2227
Mailing Address - Fax:770-445-7262
Practice Address - Street 1:110 EVANS MILL DR
Practice Address - Street 2:SUITE 305
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-1622
Practice Address - Country:US
Practice Address - Phone:678-882-2227
Practice Address - Fax:770-445-7262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005019101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA473130628AMedicaid