Provider Demographics
NPI:1003943358
Name:BATES, SUSAN SOWDER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:SOWDER
Last Name:BATES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:S
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10299 WOODMAN RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-4419
Mailing Address - Country:US
Mailing Address - Phone:804-727-8500
Mailing Address - Fax:804-727-8580
Practice Address - Street 1:17320 NEW KENT HWY
Practice Address - Street 2:
Practice Address - City:BARHAMSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23011-2353
Practice Address - Country:US
Practice Address - Phone:804-652-1253
Practice Address - Fax:804-652-1254
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040032831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA204007OtherANTHEM
VA432154OtherANTHEM