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General NPI Number Information
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NPI Number | 1316291883
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Entity Type | Individual
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Provider Name | MICHAEL DESHUN BAILEY DSW, LCSW
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Gender | Male
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 10/09/2019
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Provider Practice Location Address
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Address Line | 201 W MARSHALL ST APT 202
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City | RICHMOND
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State | VA
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Zip | 23220-3952
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Country | US
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Telephone | 804-929-9796
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Fax |
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Provider Business Mailing Address
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Address Line | 26 S 8TH ST
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City | NEWARK
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State | NJ
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Zip | 07107-2118
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Country | US
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Telephone | 804-929-9796
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05565400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904008996
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License Number State | VA
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