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General NPI Number Information
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NPI Number | 1497152185
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Entity Type | Individual
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Provider Name | SANDRA ELLEN BAILEY M.A.
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Gender | Female
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Dates
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Enumeration Date | 11/25/2014
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 6950 COLUMBIA GATEWAY DR
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City | COLUMBIA
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State | MD
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Zip | 21046-2706
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Country | US
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Telephone | 410-953-1865
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Fax |
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Provider Business Mailing Address
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Address Line | 6950 COLUMBIA GATEWAY DR
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City | COLUMBIA
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State | MD
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Zip | 21046-2706
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Country | US
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Telephone | 410-953-1865
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2060
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LC5674
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License Number State | MD
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