Provider Demographics
NPI:1154033900
Name:BAXTER, DEMOR'A CHIARA (LPC)
Entity type:Individual
Prefix:
First Name:DEMOR'A
Middle Name:CHIARA
Last Name:BAXTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 TULIP ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31415-1732
Mailing Address - Country:US
Mailing Address - Phone:912-507-3133
Mailing Address - Fax:
Practice Address - Street 1:315 COMMERCIAL DR STE C8
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3633
Practice Address - Country:US
Practice Address - Phone:912-507-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013071101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional