Provider Demographics
NPI:1790157931
Name:BAILEY, VICKI (LCSW, LISW CP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LCSW, LISW CP
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:322 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-3796
Mailing Address - Country:US
Mailing Address - Phone:706-854-7766
Mailing Address - Fax:706-854-7766
Practice Address - Street 1:322 INDIAN TRL
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-3796
Practice Address - Country:US
Practice Address - Phone:706-854-7766
Practice Address - Fax:706-854-7766
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0050981041C0700X
SC110361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical