Provider Demographics
NPI:1124475710
Name:BAKER, SANDRIEKIA (SOCIAL WORKER, LCSW)
Entity type:Individual
Prefix:
First Name:SANDRIEKIA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:SOCIAL WORKER, LCSW
Other - Prefix:
Other - First Name:SANDRIEKIA
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:202 ASHGROVE LN
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-6870
Mailing Address - Country:US
Mailing Address - Phone:337-446-1220
Mailing Address - Fax:
Practice Address - Street 1:202 ASHGROVE LN
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-6870
Practice Address - Country:US
Practice Address - Phone:337-446-1220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 1041C0700X, 171M00000X
COCSW.09929628104100000X
LA157581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCSW.09929628OtherLICENSED CLINICAL SOCIAL WORKERS
LA15758OtherLICENSED CLINICAL SOCIAL WORKERS