Basic Information
| Provider Information | |||||||||
| NPI: | 1649666090 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | STACEY | ||||||||
| MiddleName: | DANIELLE | ||||||||
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| Credential: | L.P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 WESTWIND CIR | ||||||||
| Address2: | |||||||||
| City: | LITITZ | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175438346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178750424 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 283 BUTLER RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT GRETNA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170646085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009320359 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2015 | ||||||||
| LastUpdateDate: | 04/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | PA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.