Provider Demographics
NPI:1437338308
Name:BAILEY, KIMBERLY M (CCS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:BAILEY
Suffix:
Gender:F
Credentials:CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 MYRTLE DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-3658
Mailing Address - Country:US
Mailing Address - Phone:704-606-4255
Mailing Address - Fax:704-332-0124
Practice Address - Street 1:145 REMOUNT RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5013
Practice Address - Country:US
Practice Address - Phone:704-332-9001
Practice Address - Fax:704-332-0124
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NC2622101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)