Provider Demographics
NPI:1659564177
Name:BAILEY, NAKISHA L (MFT-1)
Entity Type:Individual
Prefix:MS
First Name:NAKISHA
Middle Name:L
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MFT-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 ENTERPRISE DR STE C
Mailing Address - Street 2:
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619-9482
Mailing Address - Country:US
Mailing Address - Phone:530-295-3715
Mailing Address - Fax:530-295-3795
Practice Address - Street 1:6201 ENTERPRISE DR STE C
Practice Address - Street 2:
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619-9482
Practice Address - Country:US
Practice Address - Phone:530-295-3715
Practice Address - Fax:530-295-3795
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53172106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist