Healthcare Provider Details

I. General information

NPI: 1629912225
Provider Name (Legal Business Name): JERMAINE BAILEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 CLEVELAND AVE NW # AGE
CANTON OH
44709-3603
US

IV. Provider business mailing address

883 KENMORE BLVD
AKRON OH
44314-2147
US

V. Phone/Fax

Practice location:
  • Phone: 330-730-7026
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: