Provider Demographics
NPI:1548662075
Name:BAKER, MICHAEL DAVID (MED, LPC, CAC II, N)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:BAKER
Suffix:
Gender:M
Credentials:MED, LPC, CAC II, N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 BRYCE CIR STE B
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-4842
Mailing Address - Country:US
Mailing Address - Phone:864-810-0490
Mailing Address - Fax:864-214-0218
Practice Address - Street 1:205 BRYCE CIR STE B
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-4842
Practice Address - Country:US
Practice Address - Phone:864-810-0490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5279101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional