Healthcare Provider Details

I. General information

NPI: 1750120887
Provider Name (Legal Business Name): BAYLEY NICOLE ALLEN PEER SUPPORT, CDCA,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1856 CEDAR HILL RD
LANCASTER OH
43130-4178
US

IV. Provider business mailing address

1856 CEDAR HILL RD
LANCASTER OH
43130-4178
US

V. Phone/Fax

Practice location:
  • Phone: 740-796-8835
  • Fax:
Mailing address:
  • Phone: 740-796-8835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number005154
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number190205
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: