Provider Demographics
NPI:1720689946
Name:BAILEY, SEFA
Entity Type:Individual
Prefix:
First Name:SEFA
Middle Name:
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 1:2952 LITTLE BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:GREEN SEA
Mailing Address - State:SC
Mailing Address - Zip Code:29545-3729
Mailing Address - Country:US
Mailing Address - Phone:843-489-1025
Mailing Address - Fax:
Practice Address - Street 1:2952 LITTLE BETHEL RD
Practice Address - Street 2:
Practice Address - City:GREEN SEA
Practice Address - State:SC
Practice Address - Zip Code:29545-3729
Practice Address - Country:US
Practice Address - Phone:843-489-1025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1-21-49684103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst