Provider Demographics
NPI:1104365840
Name:GATES, NAOMI (LMSW)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:GATES
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:P O BOX 7118
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71306
Mailing Address - Country:US
Mailing Address - Phone:318-484-6850
Mailing Address - Fax:318-484-6232
Practice Address - Street 1:5411 COLISEUM BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3729
Practice Address - Country:US
Practice Address - Phone:318-794-4552
Practice Address - Fax:318-484-6232
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LA11865104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator