Provider Demographics
NPI:1841754330
Name:BATES, DANNIE A (RBT)
Entity Type:Individual
Prefix:
First Name:DANNIE
Middle Name:A
Last Name:BATES
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 RIVERSTONE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-8068
Mailing Address - Country:US
Mailing Address - Phone:910-229-9405
Mailing Address - Fax:
Practice Address - Street 1:4634 HARMONY LN
Practice Address - Street 2:
Practice Address - City:EFLAND
Practice Address - State:NC
Practice Address - Zip Code:27243-9456
Practice Address - Country:US
Practice Address - Phone:919-742-0919
Practice Address - Fax:919-304-1100
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst