Individual
LACEY DIANE BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW, VSP
Contact information
Practice address
1615 AUGUSTA RD, WEST COLUMBIA, SC 29169-5629
(803) 791-1511
Mailing address
107 HUGER ST, COLUMBIA, SC 29201-4320
(864) 431-0089
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
10159
SC
Other
Enumeration date
09/05/2012
Last updated
09/05/2012
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