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General NPI Number Information
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NPI Number | 1770836322
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Entity Type | Individual
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Provider Name | KENNETH WILLIAM BAILEY L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 10/19/2012
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 324 LOUISA AVE. SUITE125
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City | VA. BEACH
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State | VA
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Zip | 23454
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Country | US
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Telephone | 757-351-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 324 LOUISA AVE.. SUITE125 FINNEY PSYCHOTHERAPY ASSOCIATES,
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City | VA. BEACH
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State | VA
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Zip | 23454
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Country | US
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Telephone | 757-351-6400
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 0904001681
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License Number State | VA
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