Provider Demographics
NPI:1407556046
Name:BAILEY, KENDRA J
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:J
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 1:2203 BENIDORM CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-8497
Mailing Address - Country:US
Mailing Address - Phone:404-934-0439
Mailing Address - Fax:
Practice Address - Street 1:2203 BENIDORM CT
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-8497
Practice Address - Country:US
Practice Address - Phone:404-934-0439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician