Provider Demographics
NPI:1164727095
Name:BAILEY, KELTY-BROOKE (MS)
Entity Type:Individual
Prefix:
First Name:KELTY-BROOKE
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MS
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 5070
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-5001
Mailing Address - Country:US
Mailing Address - Phone:919-218-5419
Mailing Address - Fax:
Practice Address - Street 1:263 PENNY LN
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-4918
Practice Address - Country:US
Practice Address - Phone:919-218-5419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8384101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional