Provider Demographics
NPI:1861534869
Name:BAKER, CHRISTAL DONIECE (BS)
Entity type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:DONIECE
Last Name:BAKER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2190 MEMORIAL DR APT M192
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4465
Mailing Address - Country:US
Mailing Address - Phone:931-302-8401
Mailing Address - Fax:
Practice Address - Street 1:585 G. SOUTH RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3107
Practice Address - Country:US
Practice Address - Phone:931-503-0777
Practice Address - Fax:931-503-0703
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health