Provider Demographics
NPI:1730664715
Name:BAILEY, DWAYNE ANTHONY SR (CDCA)
Entity Type:Individual
Prefix:MR
First Name:DWAYNE
Middle Name:ANTHONY
Last Name:BAILEY
Suffix:SR
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 HAYDEN AVE
Mailing Address - Street 2:
Mailing Address - City:E CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-1806
Mailing Address - Country:US
Mailing Address - Phone:216-308-7830
Mailing Address - Fax:
Practice Address - Street 1:5209 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-3703
Practice Address - Country:US
Practice Address - Phone:216-881-0765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161118101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)