Provider Demographics
NPI:1639929854
Name:GATES, LAURIE (PEER SUPPORT WORKER)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:GATES
Suffix:
Gender:F
Credentials:PEER SUPPORT WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500B JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95605-2349
Mailing Address - Country:US
Mailing Address - Phone:530-702-3805
Mailing Address - Fax:
Practice Address - Street 1:500B JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95605-2349
Practice Address - Country:US
Practice Address - Phone:530-702-3805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-NTEOZA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist