Provider Demographics
NPI:1528744117
Name:KENT BAKER, MEGAN ELIZABETH (LCSWA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:KENT BAKER
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ELIZABETH
Other - Last Name:KENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4358
Mailing Address - Country:US
Mailing Address - Phone:704-874-1900
Mailing Address - Fax:
Practice Address - Street 1:215 SHADY GROVE RD
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:NC
Practice Address - Zip Code:28090-8254
Practice Address - Country:US
Practice Address - Phone:704-476-8223
Practice Address - Fax:704-538-3944
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0191251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical