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General NPI Number Information
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NPI Number | 1598536757
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Entity Type | Individual
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Provider Name | BAILEE FORD LCHMCA, NCC
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Gender | Female
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Dates
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Enumeration Date | 01/15/2024
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Last Update Date | 01/15/2024
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Provider Practice Location Address
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Address Line | 17015 KENTON DR STE 203
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City | CORNELIUS
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State | NC
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Zip | 28031-5561
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Country | US
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Telephone | 980-689-0280
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Fax |
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Provider Business Mailing Address
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Address Line | 139 NORTHBEND DR APT C
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City | CHARLOTTE
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State | NC
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Zip | 28262-4421
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Country | US
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Telephone |
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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 | A19544
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License Number State | NC
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