Provider Demographics
NPI:1124201413
Name:BAILEY-PADGETT, LYDIA CELESTINE (EDUC SPECIALIST)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:CELESTINE
Last Name:BAILEY-PADGETT
Suffix:
Gender:F
Credentials:EDUC SPECIALIST
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 47
Mailing Address - Street 2:
Mailing Address - City:STATE PARK
Mailing Address - State:SC
Mailing Address - Zip Code:29147-0047
Mailing Address - Country:US
Mailing Address - Phone:803-351-8727
Mailing Address - Fax:
Practice Address - Street 1:1333 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2923
Practice Address - Country:US
Practice Address - Phone:803-351-8727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4367101YP2500X
SC214724101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool