Provider Demographics
NPI:1487983367
Name:BALDWIN, CONNIE DENNISE (MS, LMHC(FL),LPC(TX))
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:DENNISE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:MS, LMHC(FL),LPC(TX)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 OLDE POST RD
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-3905
Mailing Address - Country:US
Mailing Address - Phone:210-885-5963
Mailing Address - Fax:
Practice Address - Street 1:3922 JACE DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-6510
Practice Address - Country:US
Practice Address - Phone:210-885-5963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63853101YP2500X
UT10460723-6004101YP2500X
FLMH5223101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional