Provider Demographics
NPI:1568637775
Name:BATES, STEPHANIE ANNE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ANNE
Last Name:BATES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 12TH ST, SUITE 101
Mailing Address - Street 2:FAMILY LIFE CENTER, BLDG 1186
Mailing Address - City:FT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060
Mailing Address - Country:US
Mailing Address - Phone:703-805-2727
Mailing Address - Fax:703-805-2440
Practice Address - Street 1:5950 12TH ST STE 101
Practice Address - Street 2:FAMILY LIFE CENTER, BLDG 1186
Practice Address - City:FT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5539
Practice Address - Country:US
Practice Address - Phone:703-805-2727
Practice Address - Fax:703-805-2440
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040067651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical