Healthcare Provider Details

I. General information

NPI: 1205108404
Provider Name (Legal Business Name): KENYATTA BATES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENYATTA CARTER

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S LINDEN RD STE J
FLINT MI
48532-5413
US

IV. Provider business mailing address

2550 S TELEGRAPH RD STE 250
BLOOMFIELD HILLS MI
48302-0909
US

V. Phone/Fax

Practice location:
  • Phone: 810-732-0560
  • Fax:
Mailing address:
  • Phone: 248-322-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801093351
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: