Provider Demographics
NPI:1558767020
Name:BAILEY, CARMELLA MONIQUE (CADC II)
Entity Type:Individual
Prefix:MS
First Name:CARMELLA
Middle Name:MONIQUE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 ADAMS AVE APT 7P
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-8323
Mailing Address - Country:US
Mailing Address - Phone:714-248-2378
Mailing Address - Fax:
Practice Address - Street 1:18912 PATRICIAN DR
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:CA
Practice Address - Zip Code:92861-4214
Practice Address - Country:US
Practice Address - Phone:714-949-9426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA021840216101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)