Provider Demographics
NPI:1861100935
Name:BAKER, LORA D (ALC)
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:D
Last Name:BAKER
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 US HIGHWAY 278 E
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-0690
Mailing Address - Country:US
Mailing Address - Phone:888-355-7080
Mailing Address - Fax:256-615-8632
Practice Address - Street 1:198 US HIGHWAY 278 E
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-0690
Practice Address - Country:US
Practice Address - Phone:888-355-7080
Practice Address - Fax:256-615-8632
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04289101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL235540Medicaid