Basic Information
| Provider Information | |||||||||
| NPI: | 1528513744 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAKER | ||||||||
| FirstName: | KENDRA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 GOVERNMENT AVE SW STE 305 | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286022954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282671740 | ||||||||
| FaxNumber: | 8282671746 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 WILKESBORO BLVD NE STE 1A | ||||||||
| Address2: | |||||||||
| City: | LENOIR | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286454498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287546087 | ||||||||
| FaxNumber: | 8287541344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2016 | ||||||||
| LastUpdateDate: | 08/17/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | A12421 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | A12421 | 01 | NC | NC LICENSE BOARD | OTHER |