MEDICARE: MS. HOLLY EVE YATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	4745	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	140X6 BCBSNC	OTHER	NC	LPC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	359258 MHN	OTHER	NC	LPC

General Provider Information

NPI Number	:	1003912262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HOLLY EVE YATES

Provider Business Mailing Address
First Line	:	4008 BARRETT DR
Second Line	:	106
City	:	RALEIGH
State	:	NC
Zip	:	27609-6621
Country	:	US
Telephone Number	:	919-931-3270
Fax Number	:	919-781-2660

Provider Business Practice Location Address
First Line	:	7633 MINE VALLEY RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-6017
Country	:	US
Telephone Number	:	919-931-3270
Fax Number	:	919-781-8660

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/09/2007

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