Provider Demographics
NPI:1881207611
Name:MINKEWICZ, BAILEY (LPC, CDCA)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:MINKEWICZ
Suffix:
Gender:F
Credentials:LPC, CDCA
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:L
Other - Last Name:VARGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, CDCA
Mailing Address - Street 1:486 S RACCOON RD APT E39
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-3620
Mailing Address - Country:US
Mailing Address - Phone:330-718-5606
Mailing Address - Fax:
Practice Address - Street 1:7031 CORPORATE WAY STE 103
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4262
Practice Address - Country:US
Practice Address - Phone:937-619-9089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2103746101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
15506459OtherCAQH
OH74123828Medicaid