Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YS0200X | School Counselor |
NPI | 1205484706 |
---|---|
Provider Name | Samara Bates |
First Address | Chattanooga, TN 37421-1894 |
Second Address | Chattanooga, TN 37421-1894 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2019 |
Last Update Date | 28/08/2019 |