Healthcare Provider Details

I. General information

NPI: 1508209065
Provider Name (Legal Business Name): LUCY LEIGH BAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 PINEY GROVE RD
COLUMBIA SC
29210-4158
US

IV. Provider business mailing address

120 PINEY GROVE RD
COLUMBIA SC
29210-4158
US

V. Phone/Fax

Practice location:
  • Phone: 803-476-4756
  • Fax:
Mailing address:
  • Phone: 803-476-4756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1414
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number193011
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: