Provider Demographics
NPI:1942503073
Name:BAISDEN, CHRISTINA ANN (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANN
Last Name:BAISDEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:ANN
Other - Last Name:KENWORTHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CHRISTINA A DORSMAN
Mailing Address - Street 1:15549 REGINA AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1904
Mailing Address - Country:US
Mailing Address - Phone:951-710-7980
Mailing Address - Fax:833-635-9446
Practice Address - Street 1:8225 ALLEN RD STE 1103
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1401
Practice Address - Country:US
Practice Address - Phone:951-588-4187
Practice Address - Fax:833-635-9446
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-12
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA644531041C0700X
MI6801197381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA64453OtherLCSW
MI680119738OtherLMSW