Provider Demographics
NPI:1720595416
Name:BAKER, VICKY (LCSW)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 OTTAWA DR
Mailing Address - Street 2:
Mailing Address - City:N LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-5325
Mailing Address - Country:US
Mailing Address - Phone:501-243-8977
Mailing Address - Fax:501-248-0088
Practice Address - Street 1:140 MUNICIPAL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4274
Practice Address - Country:US
Practice Address - Phone:501-243-8977
Practice Address - Fax:501-248-0088
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
AR8442C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker