Provider Demographics
NPI:1770972234
Name:BAILY, CHARLES DAVID RICHARD
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:DAVID RICHARD
Last Name:BAILY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 17TH ST NW
Mailing Address - Street 2:SUITE 530
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-4704
Mailing Address - Country:US
Mailing Address - Phone:571-257-3378
Mailing Address - Fax:
Practice Address - Street 1:1101 17TH ST NW
Practice Address - Street 2:SUITE 530
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-4704
Practice Address - Country:US
Practice Address - Phone:571-257-3378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist