Healthcare Provider Details

I. General information

NPI: 1962756775
Provider Name (Legal Business Name): KEHELEY BAILEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 VILLAGE CTR W
WOODSTOCK GA
30188-5206
US

IV. Provider business mailing address

3644 EDENBOURGH PL
MARIETTA GA
30066-3081
US

V. Phone/Fax

Practice location:
  • Phone: 678-665-6587
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW003044
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: