Provider Demographics
NPI:1912559923
Name:BAYLEY, KATRINA JOY
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:JOY
Last Name:BAYLEY
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 1:3611 OLDE PRESTWICK CT
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-8145
Mailing Address - Country:US
Mailing Address - Phone:404-304-0089
Mailing Address - Fax:
Practice Address - Street 1:140 E MARIETTA ST STE 301
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-3002
Practice Address - Country:US
Practice Address - Phone:770-213-3594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-19-36083103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst