Provider Demographics
NPI:1194471052
Name:BATES, JOHN RONALD (LPC-A)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:RONALD
Last Name:BATES
Suffix:
Gender:
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 BINNICKER BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-9055
Mailing Address - Country:US
Mailing Address - Phone:803-570-4165
Mailing Address - Fax:
Practice Address - Street 1:910 COOK RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2124
Practice Address - Country:US
Practice Address - Phone:803-534-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7697101Y00000X
SC8946101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC008533763Medicaid