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General NPI Number Information
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NPI Number | 1568534196
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Entity Type | Organization
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Legal Business Name | BAILEY COUNSELING SERVICE LLC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 60 CONNOLLY PKWY SUTIE 11B ROOM 108
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City | HAMDEN
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State | CT
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Zip | 06514-2593
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Country | US
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Telephone | 203-230-1831
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Fax |
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Provider Business Mailing Address
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Address Line | 60 CONNOLLY PKWY SUTIE 11B ROOM 108
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City | HAMDEN
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State | CT
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Zip | 06514-2593
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Country | US
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Telephone | 203-230-1831
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHAUNDRA BAILEY
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Credential | LCSW
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Telephone | 203-230-1831
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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 | 005631
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License Number State | CT
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