Provider Demographics
NPI:1750979308
Name:BATES, MARY ASHLEY CELESTE (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ASHLEY CELESTE
Last Name:BATES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 INTERSTATE RIDGE DR STE G
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-7076
Mailing Address - Country:US
Mailing Address - Phone:678-207-2900
Mailing Address - Fax:
Practice Address - Street 1:915 INTERSTATE RIDGE DR STE G
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-7076
Practice Address - Country:US
Practice Address - Phone:678-207-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0074251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical