Provider Demographics
NPI:1790328938
Name:BAILEY, KENDRICK DENARD (DPC, LPC-S, NCC)
Entity Type:Individual
Prefix:DR
First Name:KENDRICK
Middle Name:DENARD
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DPC, LPC-S, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 RIDGEWOOD RD STE 204
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4976
Mailing Address - Country:US
Mailing Address - Phone:769-251-5133
Mailing Address - Fax:
Practice Address - Street 1:2633 RIDGEWOOD RD STE 204
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4976
Practice Address - Country:US
Practice Address - Phone:769-251-5133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1512101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional