Individual
PHYLLIS A BAILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS. CAT
Contact information
Practice address
4744 WE ROSS PKWY APT 44-205, SOUTHAVEN, MS 38671-6386
(901) 287-1859
Mailing address
340 STATE LINE RD WEST, SOUTHAVEN, MS 38671
(662) 510-5387
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CA0232
MS
Other
Enumeration date
10/13/2021
Last updated
10/13/2021
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