Provider Demographics
NPI:1831456607
Name:BATES, TERESA ANN (MS, APC, NCC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:BATES
Suffix:
Gender:F
Credentials:MS, APC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 COLUMBIA RD.
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907
Mailing Address - Country:US
Mailing Address - Phone:706-869-7373
Mailing Address - Fax:706-869-7380
Practice Address - Street 1:4145 COLUMBIA RD.
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907
Practice Address - Country:US
Practice Address - Phone:706-869-7373
Practice Address - Fax:706-869-7380
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BA2C14AC106H00000X
GAAPC007901101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA485569088A21Medicaid