Provider Demographics
NPI:1619633021
Name:BAILEY, ALEXANDRIA (REGISTERED INTERN)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:REGISTERED INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 GANDY BLVD N APT 1303
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2322
Mailing Address - Country:US
Mailing Address - Phone:203-231-0252
Mailing Address - Fax:
Practice Address - Street 1:3840 5TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7521
Practice Address - Country:US
Practice Address - Phone:727-367-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker