Individual
SHANNON DALE BAILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., LCADC, CCS
Contact information
Practice address
105 EASTSIDE DR, GEORGETOWN, KY 40324-9797
(502) 866-0664
(502) 866-0666
Mailing address
105 EASTSIDE DR, GEORGETOWN, KY 40324-9797
(502) 866-0664
(502) 866-0666
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
168771
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
168771
LCADC
KY
05
—
80236
—
KY
Enumeration date
12/08/2011
Last updated
07/21/2023
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