Provider Demographics
NPI:1972055168
Name:BAILEY, DAWN MARIE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11289 WV HIGHWAY 47 W
Mailing Address - Street 2:
Mailing Address - City:COXS MILLS
Mailing Address - State:WV
Mailing Address - Zip Code:26342-8208
Mailing Address - Country:US
Mailing Address - Phone:304-365-7823
Mailing Address - Fax:
Practice Address - Street 1:27 TROVATO ST STE 103
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-7286
Practice Address - Country:US
Practice Address - Phone:304-623-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-04
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCP009438551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1972055168Medicaid