Extriara Charlesh Gates, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW006847 Issued in GA

Practice address

3755 Redwine Rd Apt 2216
Atlanta, GA 30344-5932

Phone

(404) 667-6791

NPI assigned

Nov 23, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brightside Medical of Michigan PC

  • Psychiatry Physician
  • San Francisco, CA
  • NPI 1144800350

  GA

  Medicare reassignment NPD
• Lavender Grove Psychotherapy

  • Clinical Social Worker
  • Atlanta, GA
  • NPI 1407465354
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574467200000",
    "number": "1033755137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3755 REDWINE RD APT 2216",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303445932",
            "telephone_number": "404-667-6791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3755 REDWINE RD APT 2216",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303445932",
            "telephone_number": "404-667-6791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GATES",
        "first_name": "EXTRIARA",
        "middle_name": "CHARLESH",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-23",
        "last_updated": "2019-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW006847",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "egates@lavendergrovepsychotherapy.com",
            "affiliation": "N",
            "endpointDescription": "business email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3755 Redwine Rd Apt 2216",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303445932",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gates Rapid Diagnostic Laboratory of Atlanta
• Adam Whitney Gates, PHARMD
• Amanda Nicole Gates, BA
• Apryle Gates, LMSW
• Candace Marie Gates, MD
• James Gates
• Jerry W Gates, D.C.
• Kelly Elizabeth Gates
• Rebecca Shealy Gates, M.ED, CCC-SLP
• Tiffany C Gates, LMT

• Clinical Social Worker in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.