Provider Demographics
NPI:1932138492
Name:BAILEY, DAVID WAYNE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WAYNE
Last Name:BAILEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:702 N MAIN ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2900
Mailing Address - Country:US
Mailing Address - Phone:870-204-6980
Mailing Address - Fax:870-204-6981
Practice Address - Street 1:702 N MAIN ST
Practice Address - Street 2:SUITE F
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2900
Practice Address - Country:US
Practice Address - Phone:870-204-6980
Practice Address - Fax:870-204-6981
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2407-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical