Healthcare Provider Details

I. General information

NPI: 1992124630
Provider Name (Legal Business Name): BRANDALYN BATES LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRANDALYN KEMP

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 WOODLYN CHASE NE
CONYERS GA
30012-5232
US

IV. Provider business mailing address

1203 WOODLYN CHASE NE
CONYERS GA
30012-5232
US

V. Phone/Fax

Practice location:
  • Phone: 330-261-1790
  • Fax:
Mailing address:
  • Phone: 330-397-8870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.1000484
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.1801001
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC013851
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1000484
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberC.1000484
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: