MEDICARE: HOLLY E YATES MSW, LGSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	BP00945554	WV

General Provider Information

NPI Number	:	1457049611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY E YATES MSW, LGSW

Provider Business Mailing Address
First Line	:	174 COOLIDGE DR
Second Line	:
City	:	INWOOD
State	:	WV
Zip	:	25428-3768
Country	:	US
Telephone Number	:	304-671-8006
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 MEDICAL CT STE 108
Second Line	:
City	:	MARTINSBURG
State	:	WV
Zip	:	25401-3854
Country	:	US
Telephone Number	:	304-268-5330
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2023
Last Update Date	:	02/03/2026

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