Basic Information
| Provider Information | |||||||||
| NPI: | 1649677386 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | IAN | ||||||||
| MiddleName: | PAULL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LGPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7474 GREENWAY CENTER DR | ||||||||
| Address2: | SUITE 730 | ||||||||
| City: | GREENBELT | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207703504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013451022 | ||||||||
| FaxNumber: | 3015605558 | ||||||||
| Practice Location | |||||||||
| Address1: | 5820 YORK RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212123610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013451022 | ||||||||
| FaxNumber: | 4106953511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2014 | ||||||||
| LastUpdateDate: | 02/03/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LGP5934 | MD | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.