Provider Demographics
NPI:1427199405
Name:BATES, SARAH JANE (CDP-NCRPI)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:JANE
Last Name:BATES
Suffix:
Gender:F
Credentials:CDP-NCRPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 SE EVERETT MALL WAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-2833
Mailing Address - Country:US
Mailing Address - Phone:425-609-5505
Mailing Address - Fax:425-609-5506
Practice Address - Street 1:1031 SE EVERETT MALL WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-2833
Practice Address - Country:US
Practice Address - Phone:425-609-5505
Practice Address - Fax:425-609-5506
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00001545101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)