MEDICARE: MS. CARMELLA MONIQUE BAILEY CADC II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	A021840216	CA

General Provider Information

NPI Number	:	1558767020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARMELLA MONIQUE BAILEY CADC II

Provider Business Mailing Address
First Line	:	1300 ADAMS AVE APT 7P
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-8323
Country	:	US
Telephone Number	:	714-248-2378
Fax Number	:

Provider Business Practice Location Address
First Line	:	18912 PATRICIAN DR
Second Line	:
City	:	VILLA PARK
State	:	CA
Zip	:	92861-4214
Country	:	US
Telephone Number	:	714-949-9426
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2014
Last Update Date	:	03/17/2018

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