Individual
KENNISE J BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
2343 DULLES STATION BLVD APT B04, HERNDON, VA 20171-6397
(571) 241-9834
Mailing address
11415 ISAAC NEWTON SQ S, RESTON, VA 20190-5005
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0903003470
VA
Other
Enumeration date
03/20/2023
Last updated
03/23/2023
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