Provider Demographics
NPI:1881293025
Name:BAXTER-BAGGETT, DAVENA ANN (LCSW)
Entity type:Individual
Prefix:
First Name:DAVENA
Middle Name:ANN
Last Name:BAXTER-BAGGETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DAVENA
Other - Middle Name:ANN
Other - Last Name:BAXTER BAGGETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:165 BLUE RIDGE OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-4431
Mailing Address - Country:US
Mailing Address - Phone:706-946-5607
Mailing Address - Fax:706-374-7628
Practice Address - Street 1:1008 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-2118
Practice Address - Country:US
Practice Address - Phone:706-517-2273
Practice Address - Fax:706-517-2469
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0047621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003247877Medicaid