Provider Demographics
NPI:1427590843
Name:BAILEY, EDDIE LEE JR
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:LEE
Last Name:BAILEY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:EDDIE
Other - Middle Name:LEE
Other - Last Name:BAILEY
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:12010 LINWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-1108
Mailing Address - Country:US
Mailing Address - Phone:734-772-7665
Mailing Address - Fax:313-867-0706
Practice Address - Street 1:12010 LINWOOD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-1108
Practice Address - Country:US
Practice Address - Phone:734-772-7665
Practice Address - Fax:313-867-0706
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)