Provider Demographics
NPI:1417581067
Name:BAILEY, AMANDA (BS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 RIVERBIRCH DR
Mailing Address - Street 2:
Mailing Address - City:VASS
Mailing Address - State:NC
Mailing Address - Zip Code:28394-9557
Mailing Address - Country:US
Mailing Address - Phone:931-217-3447
Mailing Address - Fax:
Practice Address - Street 1:185 WOOSTER RD
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-2354
Practice Address - Country:US
Practice Address - Phone:910-690-8124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-22
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18457101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health