Individual
BAILEY VICKERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2811 TRICOM ST, NORTH CHARLESTON, SC 29406-9172
(843) 619-7989
Mailing address
2811 TRICOM ST, NORTH CHARLESTON, SC 29406-9172
(843) 619-7989
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
254173
KY
1041C0700X
Clinical Social Worker
Primary
14987
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790731081
—
KY
Enumeration date
07/16/2019
Last updated
05/13/2022
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