Provider Demographics
NPI:1811403801
Name:BAILEY, EVELYN LYNETTE (BA,SWA,LCDCIII)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:LYNETTE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:BA,SWA,LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 CARNEGIE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-4371
Mailing Address - Country:US
Mailing Address - Phone:216-440-0051
Mailing Address - Fax:
Practice Address - Street 1:JORDAN COMMUNITY RESIDENTIAL CENTER
Practice Address - Street 2:2231 NORTH TAYLOR RD
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44112
Practice Address - Country:US
Practice Address - Phone:216-441-2496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-28
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH130328101YA0400X
OH1500019104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)