Provider Demographics
NPI:1215961222
Name:BALDWIN, MARY ELAINE (EDD, LPC)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELAINE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:EDD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9111 KETTERING WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-7704
Mailing Address - Country:US
Mailing Address - Phone:865-539-4896
Mailing Address - Fax:865-539-6138
Practice Address - Street 1:244 N PETERS RD STE 211
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4935
Practice Address - Country:US
Practice Address - Phone:865-694-6177
Practice Address - Fax:865-694-6138
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN522101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health