Healthcare Provider Details

I. General information

NPI: 1497390058
Provider Name (Legal Business Name): BAILEY, CROSS & DAVIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 CRAIN HWY STE 510
WALDORF MD
20601-2819
US

IV. Provider business mailing address

2670 CRAIN HWY STE 510
WALDORF MD
20601-2819
US

V. Phone/Fax

Practice location:
  • Phone: 301-374-8772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: KECIA WRIGHT
Title or Position: OWNER
Credential: LCPC
Phone: 240-216-2713