Provider Demographics
NPI:1588724702
Name:BAILEY, FREDERICA ALSTON (MHP)
Entity type:Individual
Prefix:MRS
First Name:FREDERICA
Middle Name:ALSTON
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8926
Mailing Address - Country:US
Mailing Address - Phone:770-873-4154
Mailing Address - Fax:770-995-6958
Practice Address - Street 1:595 OLD NORCROSS RD STE B
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-7667
Practice Address - Country:US
Practice Address - Phone:770-995-6901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health