Provider Demographics
NPI:1891295416
Name:BAILEY, ADRIENNE RACHELLE
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:RACHELLE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 MADERA ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-6328
Mailing Address - Country:US
Mailing Address - Phone:925-642-0007
Mailing Address - Fax:
Practice Address - Street 1:399 MADERA ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-6328
Practice Address - Country:US
Practice Address - Phone:925-642-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician