Provider Demographics
NPI:1265699417
Name:BAILYE, APRIL DIANE (LCSW)
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:DIANE
Last Name:BAILYE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 TIMBER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4233
Mailing Address - Country:US
Mailing Address - Phone:901-566-1002
Mailing Address - Fax:901-566-1951
Practice Address - Street 1:6857 COBBLESTONE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-9312
Practice Address - Country:US
Practice Address - Phone:662-253-8040
Practice Address - Fax:662-470-5984
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
AR3123-C1041C0700X
MS87381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker