Provider Demographics
NPI:1073626107
Name:BATES, ROLEDA DAWNIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROLEDA
Middle Name:DAWNIA
Last Name:BATES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ROLEDA
Other - Middle Name:DAWNIA
Other - Last Name:DICKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6833 STOCKTON BLVD STE 485
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2376
Mailing Address - Country:US
Mailing Address - Phone:916-384-0800
Mailing Address - Fax:916-429-7824
Practice Address - Street 1:6833 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2372
Practice Address - Country:US
Practice Address - Phone:916-394-0800
Practice Address - Fax:916-429-7824
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS215841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA104100000OtherLCSW