Provider Demographics
NPI:1447907621
Name:BAILEY, DESTINEE MICHELLE (LMSW)
Entity type:Individual
Prefix:
First Name:DESTINEE
Middle Name:MICHELLE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1257 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-3911
Mailing Address - Country:US
Mailing Address - Phone:321-604-6375
Mailing Address - Fax:
Practice Address - Street 1:1257 S PARK AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-3911
Practice Address - Country:US
Practice Address - Phone:321-604-6375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107157104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker