Provider Demographics
NPI:1114390929
Name:BAILEY, LAWANNA
Entity Type:Individual
Prefix:
First Name:LAWANNA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 FERRAND ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3249
Mailing Address - Country:US
Mailing Address - Phone:318-342-9979
Mailing Address - Fax:318-342-9980
Practice Address - Street 1:2414 FERRAND ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3249
Practice Address - Country:US
Practice Address - Phone:318-342-9979
Practice Address - Fax:318-342-9980
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health