Healthcare Provider Details

I. General information

NPI: 1255582847
Provider Name (Legal Business Name): LOUISE BAILEY-WALKER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8317 OFFICE PARK DR SUITE 1A
DOUGLASVILLE GA
30134-6936
US

IV. Provider business mailing address

6370 SHALLOWFORD WAY
DOUGLASVILLE GA
30135-5428
US

V. Phone/Fax

Practice location:
  • Phone: 678-230-5831
  • Fax: 678-715-7235
Mailing address:
  • Phone: 678-230-5831
  • Fax: 678-715-7235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00008633
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC004409
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number727875
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: