Provider Demographics
NPI:1093256117
Name:SCOTT W. MATES, LLC
Entity Type:Organization
Organization Name:SCOTT W. MATES, LLC
Other - Org Name:COMPASSIONATLEY ROOTED COUNSELING AND THERAPUTIC PRACTICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MATES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:804-464-7202
Mailing Address - Street 1:7600 ALVARADO RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4204
Mailing Address - Country:US
Mailing Address - Phone:804-464-7202
Mailing Address - Fax:804-414-7742
Practice Address - Street 1:1901 HUGUENOT RD
Practice Address - Street 2:SUITE 310
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4311
Practice Address - Country:US
Practice Address - Phone:804-464-7202
Practice Address - Fax:804-414-7742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040083091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty