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General NPI Number Information
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NPI Number | 1346448651
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Entity Type | Individual
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Provider Name | NINA DIANA FARLEY-BATES L.C.S.W., D.B.H
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Gender | Female
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Dates
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Enumeration Date | 07/08/2007
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 49063 ROAD 426 STE A
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City | OAKHURST
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State | CA
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Zip | 93644-9487
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Country | US
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Telephone | 559-760-0484
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Fax | 559-689-3354
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Provider Business Mailing Address
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Address Line | 40034 ROAD 415
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City | COARSEGOLD
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State | CA
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Zip | 93614-8832
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Country | US
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Telephone | 559-760-5798
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Fax | 559-689-3354
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS24358
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License Number State | CA
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