Provider Demographics
NPI:1205108404
Name:BATES, KENYATTA (LMSW)
Entity type:Individual
Prefix:MS
First Name:KENYATTA
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KENYATTA
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2550 S TELEGRAPH RD STE 250
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0909
Mailing Address - Country:US
Mailing Address - Phone:248-322-0003
Mailing Address - Fax:
Practice Address - Street 1:2222 S LINDEN RD STE J
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5413
Practice Address - Country:US
Practice Address - Phone:810-732-0560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010933511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical