Provider Demographics
NPI:1124197850
Name:BAILLIF, PAUL ALEXANDER (LPC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ALEXANDER
Last Name:BAILLIF
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5260
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5260
Mailing Address - Country:US
Mailing Address - Phone:704-662-7977
Mailing Address - Fax:704-662-9204
Practice Address - Street 1:484 WILLIAMSON RD
Practice Address - Street 2:SUITE E-105
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8191
Practice Address - Country:US
Practice Address - Phone:704-662-7977
Practice Address - Fax:704-662-9204
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4401101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health