Provider Demographics
NPI:1487809992
Name:BAKER, DAVID CONRAD (LPC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CONRAD
Last Name:BAKER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 DUG GAP RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-5007
Mailing Address - Country:US
Mailing Address - Phone:706-279-0405
Mailing Address - Fax:706-279-4190
Practice Address - Street 1:1267 MOUNT OLIVE RD
Practice Address - Street 2:
Practice Address - City:LOOKOUT MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30750-2930
Practice Address - Country:US
Practice Address - Phone:706-639-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006479101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional