Provider Demographics
NPI:1376083675
Name:BAILEY, KARINA T
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:T
Last Name:BAILEY
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 1:2500 DALLAS HWY SW # 202-1511
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-2567
Mailing Address - Country:US
Mailing Address - Phone:610-675-3733
Mailing Address - Fax:267-433-3994
Practice Address - Street 1:625 S MARIETTA PKWY SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2748
Practice Address - Country:US
Practice Address - Phone:470-377-7228
Practice Address - Fax:470-467-7583
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014073101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional