Doctor Name: | IAN PAULL BAILEY |
NPI Number: | 1649677386 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LGPC |
License Number: | LGP5934 |
Business Practice Address: | 6707 Whitestone Rd Suite 106 Woodlawn, MD - 212074106 |
Business Phone Number: | 4438789827 |
Business Fax Number: | |
Mailing Address: | 3610 Bancroft Rd, BALTIMORE |
State: | MD |
Postal Code: | 212153227 |
Phone Number: | 4438789827 |
Fax Number: | |
NPI Enumeration Date: | 11/24/2014 |
NPI Last Update Date: | 11/24/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LGP5934 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |