Provider Demographics
NPI:1982459939
Name:GATES, LYFE L
Entity Type:Individual
Prefix:MS
First Name:LYFE
Middle Name:L
Last Name:GATES
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 1:3708 DIANNA RD
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-2226
Mailing Address - Country:US
Mailing Address - Phone:202-560-0003
Mailing Address - Fax:
Practice Address - Street 1:3708 DIANNA RD
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-2226
Practice Address - Country:US
Practice Address - Phone:202-560-0003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator