Healthcare Provider Details

I. General information

NPI: 1437671872
Provider Name (Legal Business Name): JESSICA SUE BATES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 TARPON TRL
JACKSONVILLE NC
28546-5287
US

IV. Provider business mailing address

1594 NC HIGHWAY 101
BEAUFORT NC
28516-7731
US

V. Phone/Fax

Practice location:
  • Phone: 910-938-1114
  • Fax: 910-938-1118
Mailing address:
  • Phone: 910-546-9417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC014909
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: