Provider Demographics
NPI:1982596763
Name:NWOBILOR BAKER, CHISHA IDA MAXINE
Entity type:Individual
Prefix:
First Name:CHISHA
Middle Name:IDA MAXINE
Last Name:NWOBILOR BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 STONECREST PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6897
Mailing Address - Country:US
Mailing Address - Phone:615-247-6831
Mailing Address - Fax:615-728-7640
Practice Address - Street 1:521 STONECREST PKWY STE 102
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6897
Practice Address - Country:US
Practice Address - Phone:615-247-6831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN98151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical