Provider Demographics
NPI:1952501876
Name:BAILEY, ANDREA LATRICE-CHANTAL
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LATRICE-CHANTAL
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 1:307 TEAL LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4719
Mailing Address - Country:US
Mailing Address - Phone:281-772-2409
Mailing Address - Fax:713-772-6831
Practice Address - Street 1:307 TEAL LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4719
Practice Address - Country:US
Practice Address - Phone:281-772-2409
Practice Address - Fax:713-772-6831
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator