Provider Demographics
NPI:1275360018
Name:GATES, EMILY (MA, NCC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GATES
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4404 KEITH RD
Mailing Address - Street 2:
Mailing Address - City:HOGANSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30230-4188
Mailing Address - Country:US
Mailing Address - Phone:770-316-8826
Mailing Address - Fax:
Practice Address - Street 1:230 W COLLEGE ST STE D
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4249
Practice Address - Country:US
Practice Address - Phone:678-688-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health