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Individual
MS. CARLA ANDREA BAUCOM
Active
Individual
MS. CARLA ANDREA BAUCOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
253J00000X
Foster Care Agency
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/01/2019
Last updated
09/01/2019
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