Provider Demographics
NPI:1033478185
Name:YATES, DEBORAH PATRICIA
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:PATRICIA
Last Name:YATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28312
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-0312
Mailing Address - Country:US
Mailing Address - Phone:804-874-4230
Mailing Address - Fax:
Practice Address - Street 1:9355 KEMPTON MANOR CT
Practice Address - Street 2:1702
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3883
Practice Address - Country:US
Practice Address - Phone:804-874-4230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAY12055000171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator