Provider Demographics
NPI:1386813715
Name:YATES, MAYDEAN (LCSW, MCAP, CRRA)
Entity Type:Individual
Prefix:MS
First Name:MAYDEAN
Middle Name:
Last Name:YATES
Suffix:
Gender:F
Credentials:LCSW, MCAP, CRRA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 S GLEN AVE UNIT 7
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4675
Mailing Address - Country:US
Mailing Address - Phone:813-360-6014
Mailing Address - Fax:
Practice Address - Street 1:217 N LOIS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2232
Practice Address - Country:US
Practice Address - Phone:813-360-6014
Practice Address - Fax:813-358-3605
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL100276101YA0400X
FL100472101YA0400X
FLSW97691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)