Provider Demographics
NPI:1093388118
Name:BATES, MICHELLE (LCSW)
Entity Type:Individual
Prefix:PROF
First Name:MICHELLE
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 RIVER OAK ST
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-9630
Mailing Address - Country:US
Mailing Address - Phone:910-797-1348
Mailing Address - Fax:
Practice Address - Street 1:56 RIVER OAK ST
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-9630
Practice Address - Country:US
Practice Address - Phone:910-797-1348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0143851041C0700X
NCC0148321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty