Provider Demographics
NPI:1376694489
Name:SMITH-BAILEY, PATRICIA ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:SMITH-BAILEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4650
Mailing Address - Country:US
Mailing Address - Phone:919-881-7774
Mailing Address - Fax:919-881-2123
Practice Address - Street 1:4000 BLUE RIDGE RD
Practice Address - Street 2:SUITE 140
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4650
Practice Address - Country:US
Practice Address - Phone:919-881-7774
Practice Address - Fax:919-881-2123
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0004781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC18600OtherBLUECROSSBLUESHIELD