Healthcare Provider Details

I. General information

NPI: 1336850957
Provider Name (Legal Business Name): LUEVENIA DONELLA BAILEY CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W 30TH ST
LORAIN OH
44055-1073
US

IV. Provider business mailing address

515 W 30TH ST
LORAIN OH
44055-1073
US

V. Phone/Fax

Practice location:
  • Phone: 440-258-0450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.182732
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: