Provider Demographics
NPI:1316291883
Name:BAILEY, MICHAEL DESHUN (DSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DESHUN
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-2118
Mailing Address - Country:US
Mailing Address - Phone:804-929-9796
Mailing Address - Fax:
Practice Address - Street 1:201 W MARSHALL ST APT 202
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-3952
Practice Address - Country:US
Practice Address - Phone:804-929-9796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055654001041C0700X
VA09040089961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical