Provider Demographics
NPI:1083943054
Name:BAILEY, SHERISSE KELLY (LCMHCS,LCASMCCS)
Entity type:Individual
Prefix:MRS
First Name:SHERISSE
Middle Name:KELLY
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LCMHCS,LCASMCCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2443 LYNN RD STE 112
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-6759
Mailing Address - Country:US
Mailing Address - Phone:919-741-2349
Mailing Address - Fax:919-887-2078
Practice Address - Street 1:2443 LYNN RD STE 112
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-6759
Practice Address - Country:US
Practice Address - Phone:919-741-2349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1988101YA0400X
NC7644101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional