Provider Demographics
NPI:1255804902
Name:YATES, BETHANY (LCSW-C)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:YATES
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21095 MATTIE LN APT 308
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-6228
Mailing Address - Country:US
Mailing Address - Phone:240-434-8154
Mailing Address - Fax:
Practice Address - Street 1:21095 MATTIE LN APT 308
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-6228
Practice Address - Country:US
Practice Address - Phone:240-434-8154
Practice Address - Fax:240-210-9238
Is Sole Proprietor?:No
Enumeration Date:2019-01-05
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23179104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker