Provider Demographics
NPI:1003654500
Name:COLEMAN, BAILEY ANN
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:ANN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13201 BROOKSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-8170
Mailing Address - Country:US
Mailing Address - Phone:828-679-5443
Mailing Address - Fax:
Practice Address - Street 1:13201 BROOKSTONE WAY
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-8170
Practice Address - Country:US
Practice Address - Phone:828-679-5443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst