Provider Demographics
NPI:1063072346
Name:BATES, CANDICE LYNN (BS)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:LYNN
Last Name:BATES
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103A ROGERS RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-5767
Mailing Address - Country:US
Mailing Address - Phone:302-268-9440
Mailing Address - Fax:302-268-9450
Practice Address - Street 1:103A ROGERS RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-5767
Practice Address - Country:US
Practice Address - Phone:302-268-9440
Practice Address - Fax:302-268-9450
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional