Provider Demographics
NPI:1699913020
Name:BAKER, JEFFREY L (PHD, MAC,HS-BCP)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:L
Last Name:BAKER
Suffix:
Gender:M
Credentials:PHD, MAC,HS-BCP
Other - Prefix:MR
Other - First Name:JEFF
Other - Middle Name:L
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAC, CCJAP,CAPP
Mailing Address - Street 1:8014 CUMMING HWY
Mailing Address - Street 2:SUITE 403-302
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-9339
Mailing Address - Country:US
Mailing Address - Phone:404-806-0434
Mailing Address - Fax:770-720-2335
Practice Address - Street 1:8014 CUMMING HWY
Practice Address - Street 2:SUITE 403-302
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-9339
Practice Address - Country:US
Practice Address - Phone:404-806-0434
Practice Address - Fax:770-720-2335
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL335G102L00000X, 246Y00000X
FL160101YA0400X
NC101YP2500X, 1041C0700X, 101YM0800X, 171M00000X, 170300000X
FL1041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No170300000XOther Service ProvidersGenetic Counselor, MS