Provider Demographics
NPI:1720031016
Name:BAILEY, GARY BERNARD (MA, MSW, PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:BERNARD
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MA, MSW, PHD, LCSW
Other - Prefix:
Other - First Name:ALAMANCE
Other - Middle Name:EAP, LLC
Other - Last Name:LIFE WORKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:291 N GRAHAM HOPEDALE RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-2971
Mailing Address - Country:US
Mailing Address - Phone:336-228-0793
Mailing Address - Fax:877-227-0793
Practice Address - Street 1:291 N GRAHAM HOPEDALE RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2971
Practice Address - Country:US
Practice Address - Phone:336-228-0793
Practice Address - Fax:877-227-0793
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC129101Y00000X
VA0904 0028031041C0700X
NC38595103TH0100X
NCC0003001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002358Medicaid
NC6002358Medicaid
NC510489621Medicare UPIN
NC2861155Medicare ID - Type UnspecifiedMEDICARE