Provider Demographics
NPI:1952040495
Name:BAILEY, LALA NAN
Entity type:Individual
Prefix:
First Name:LALA
Middle Name:NAN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LALA
Other - Middle Name:NAN
Other - Last Name:HOLLAMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 NC 54 APT 202
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1630
Mailing Address - Country:US
Mailing Address - Phone:910-619-2051
Mailing Address - Fax:
Practice Address - Street 1:123 KINGSTON DR STE 105
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1651
Practice Address - Country:US
Practice Address - Phone:919-709-7307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical