Provider Demographics
NPI:1558079376
Name:GATES, ELAINA MAE (LMSW)
Entity Type:Individual
Prefix:
First Name:ELAINA
Middle Name:MAE
Last Name:GATES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ELAINA
Other - Middle Name:
Other - Last Name:HOGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:12941 DEVOE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2367
Mailing Address - Country:US
Mailing Address - Phone:313-327-6408
Mailing Address - Fax:
Practice Address - Street 1:1423 FIELD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-2321
Practice Address - Country:US
Practice Address - Phone:313-924-7860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011153251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical