Provider Demographics
NPI:1295989044
Name:BAKER-CRELLIN, PA
Entity type:Organization
Organization Name:BAKER-CRELLIN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAKER-CRELLIN
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW, LCSW, CSAC
Authorized Official - Phone:704-660-8321
Mailing Address - Street 1:267 SPRING RUN DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8133
Mailing Address - Country:US
Mailing Address - Phone:704-660-8321
Mailing Address - Fax:
Practice Address - Street 1:107 KILSON DR
Practice Address - Street 2:SUITE 202
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8162
Practice Address - Country:US
Practice Address - Phone:704-660-8321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC005161261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)