Provider Demographics
NPI:1801997507
Name:BAILEY HENRY, MARY ANN (LCSW)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:BAILEY HENRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S INDEPENDENCE BLVD
Mailing Address - Street 2:STE 207
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1150
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 S INDEPENDENCE BLVD
Practice Address - Street 2:STE 207
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1150
Practice Address - Country:US
Practice Address - Phone:757-497-4965
Practice Address - Fax:757-497-4197
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904003282104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
055499OtherANTHEM BLUE CROSS
000809OtherVALUE OPTIONS
344120OtherTRICARE