Provider Demographics
NPI:1023500105
Name:BAIRD, JESSICA (CCLS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BAIRD
Suffix:
Gender:F
Credentials:CCLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6205 MONROE AVENUE
Mailing Address - Street 2:
Mailing Address - City:SKYESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784
Mailing Address - Country:US
Mailing Address - Phone:253-651-8134
Mailing Address - Fax:
Practice Address - Street 1:6205 MONROE AVENUE
Practice Address - Street 2:
Practice Address - City:SKYESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784
Practice Address - Country:US
Practice Address - Phone:253-651-8134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2022-01-02
Deactivation Date:2021-04-07
Deactivation Code:
Reactivation Date:2021-05-25
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MDLGP12089101YP2500X
20946174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional