=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386931285
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA TERESA BATES CACII, NCACII
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2011
-----------------------------------------------------
Last Update Date | 06/30/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 HUDSON ST
-----------------------------------------------------
City | CHESTER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29706-1524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-377-8111
-----------------------------------------------------
Fax | 803-581-5380
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 130 HUDSON ST PO BOX 636
-----------------------------------------------------
City | CHESTER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29706-1524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-377-8111
-----------------------------------------------------
Fax | 803-581-5380
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------