Provider Demographics
NPI:1962590646
Name:BAXTER, LISA MARIE HANKS (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE HANKS
Last Name:BAXTER
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 1:129 E ST
Mailing Address - Street 2:SUITE C-3
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4658
Mailing Address - Country:US
Mailing Address - Phone:530-753-1309
Mailing Address - Fax:530-758-0864
Practice Address - Street 1:129 E ST
Practice Address - Street 2:SUITE C-3
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4658
Practice Address - Country:US
Practice Address - Phone:530-753-1309
Practice Address - Fax:530-758-0864
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS101241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical