Provider Demographics
NPI:1578196226
Name:BATES, JOSEFINA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:JOSEFINA
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 ARBOR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1287
Mailing Address - Country:US
Mailing Address - Phone:678-808-9244
Mailing Address - Fax:
Practice Address - Street 1:365 NORTHRIDGE RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-3207
Practice Address - Country:US
Practice Address - Phone:678-808-9244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0070721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical