Provider Demographics
NPI:1295105005
Name:MACHUCA, BAILEY R (LPCA)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:R
Last Name:MACHUCA
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10801 MONROE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-8335
Mailing Address - Country:US
Mailing Address - Phone:704-237-4240
Mailing Address - Fax:
Practice Address - Street 1:10801 MONROE RD
Practice Address - Street 2:SUITE A
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-8335
Practice Address - Country:US
Practice Address - Phone:704-237-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11495101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health