Provider Demographics
NPI:1891969259
Name:OATES, VIRGINIA M
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:M
Last Name:OATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 KORNEGAY DR
Mailing Address - Street 2:
Mailing Address - City:DUDLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28333-9351
Mailing Address - Country:US
Mailing Address - Phone:919-222-6278
Mailing Address - Fax:
Practice Address - Street 1:208 WAYNE AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-6427
Practice Address - Country:US
Practice Address - Phone:919-739-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC096-206101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health