Organization
AVALON PSYCHOLOGICAL CENTER, PLLC
Active
Organization
AVALON PSYCHOLOGICAL CENTER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VAUNETTE L. BAKER LPP (OWNER)
(606) 677-0053
Entity
Organization
Contact information
Practice address
106 SOUTHPORT DR., SOMERSET, KY 42501
(606) 677-0053
(606) 677-0060
Mailing address
106 SOUTHPORT DR., SOMERSET, KY 42501
(606) 677-0053
(606) 677-0060
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0864
KY
103TC1900X
Counseling Psychologist
Primary
0068
KY
1041C0700X
Clinical Social Worker
2057
KY
1041C0700X
Clinical Social Worker
350
KY
Other
Enumeration date
09/26/2011
Last updated
04/08/2015
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