Basic Information
| Provider Information | |||||||||
| NPI: | 1376054122 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAIRD | ||||||||
| FirstName: | CHARLENE | ||||||||
| MiddleName: | GERTRUDE | ||||||||
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| Credential: | AMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 649 E ALBERTONI ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | CARSON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907461538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104369300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 649 E ALBERTONI ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | CARSON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907461538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104369300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2017 | ||||||||
| LastUpdateDate: | 08/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CI27350519 | CA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 106H00000X | AMFT133821 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.