Provider Demographics
NPI:1972724748
Name:BATES, VICTORIA (LMBT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POB 112
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:NC
Mailing Address - Zip Code:28076
Mailing Address - Country:US
Mailing Address - Phone:828-657-4644
Mailing Address - Fax:828-657-4145
Practice Address - Street 1:3072 US 221-A
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:NC
Practice Address - Zip Code:28076
Practice Address - Country:US
Practice Address - Phone:828-657-4644
Practice Address - Fax:828-657-4145
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNCLMBT 468174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist