Individual
STACEY YATES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3272 LARK HAVEN DR NW, KENNESAW, GA 30152-3278
(615) 473-9963
Mailing address
3272 LARK HAVEN DR NW, KENNESAW, GA 30152-3278
(615) 473-9963
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
MSW012820
GA
1041S0200X
School Social Worker
1883232
GA
Other
Enumeration date
01/13/2026
Last updated
01/13/2026
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