Provider Demographics
NPI:1427451137
Name:BAILEY, AMY NICOLE (LMSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:NICOLE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:NICOLE
Other - Last Name:VENARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:4222 CADDO AVE SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2436
Mailing Address - Country:US
Mailing Address - Phone:616-326-1630
Mailing Address - Fax:
Practice Address - Street 1:959 LAKE DR SE
Practice Address - Street 2:SUITE 6
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-1447
Practice Address - Country:US
Practice Address - Phone:616-326-1630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010901651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical