Healthcare Provider Details

I. General information

NPI: 1922107366
Provider Name (Legal Business Name): ROSETTA S BAILEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E WOODROW WILSON AVE
JACKSON MS
39216-5116
US

IV. Provider business mailing address

115 BRITTANY WAY
MADISON MS
39110-7928
US

V. Phone/Fax

Practice location:
  • Phone: 601-364-1289
  • Fax: 601-368-3875
Mailing address:
  • Phone: 601-953-1701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberC6381
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: