Provider Demographics
NPI:1528513744
Name:BAKER, KENDRA (LPCA)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 GOVERNMENT AVE SW STE 305
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-2954
Mailing Address - Country:US
Mailing Address - Phone:828-267-1740
Mailing Address - Fax:828-267-1746
Practice Address - Street 1:315 WILKESBORO BLVD NE STE 1A
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-4498
Practice Address - Country:US
Practice Address - Phone:828-754-6087
Practice Address - Fax:828-754-1344
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12421101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA12421OtherNC LICENSE BOARD