Provider Demographics
NPI:1295872398
Name:BALDWIN, TRIXY M (NCC, LPC, LCAS)
Entity type:Individual
Prefix:
First Name:TRIXY
Middle Name:M
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:NCC, LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3962 CANE GARDEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-5696
Mailing Address - Country:US
Mailing Address - Phone:919-291-7313
Mailing Address - Fax:919-926-7508
Practice Address - Street 1:312 W MILLBROOK RD
Practice Address - Street 2:121
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4389
Practice Address - Country:US
Practice Address - Phone:919-291-7313
Practice Address - Fax:919-926-7508
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4618101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102584Medicaid