Provider Demographics
NPI:1801944327
Name:GATES, SIDNEY AUSTIN JR (LMFT)
Entity type:Individual
Prefix:MR
First Name:SIDNEY
Middle Name:AUSTIN
Last Name:GATES
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3633 WHEELER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6550
Mailing Address - Country:US
Mailing Address - Phone:706-364-0252
Mailing Address - Fax:706-364-0269
Practice Address - Street 1:3633 WHEELER RD
Practice Address - Street 2:SUITE 110
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6549
Practice Address - Country:US
Practice Address - Phone:706-855-7784
Practice Address - Fax:706-651-1090
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000750106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist