Provider Demographics
NPI:1104103126
Name:BAKER, TONEISHA FAYETT (M ED, LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:TONEISHA
Middle Name:FAYETT
Last Name:BAKER
Suffix:
Gender:F
Credentials:M ED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 BRANDIMERE DR
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-2808
Mailing Address - Country:US
Mailing Address - Phone:706-619-0179
Mailing Address - Fax:
Practice Address - Street 1:2812 HILLCREEK DR STE B
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-5632
Practice Address - Country:US
Practice Address - Phone:678-909-8671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2021-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006541101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC006541OtherLICENSE NUMBER
GA231442OtherNATIONAL CERTIFIED COUNSELOR