Healthcare Provider Details

I. General information

NPI: 1194326124
Provider Name (Legal Business Name): VANESSA BAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 03/11/2023
Certification Date: 03/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 FAIRWIND DR APT 317
CHESAPEAKE VA
23320-4054
US

IV. Provider business mailing address

5267 GREENWICH RD STE 101E
VIRGINIA BEACH VA
23462-6028
US

V. Phone/Fax

Practice location:
  • Phone: 757-206-2378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701012239
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: