Individual
CHARLES JASON YATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, LCAS, CCS
Contact information
Practice address
102 CHESTNUT DR, HIGH POINT, NC 27262-6804
(336) 991-1567
(336) 886-4160
Mailing address
111 EDGEVIEW RD, HIGH POINT, NC 27260-4319
(336) 991-1567
(336) 886-4160
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1548
NC
1041C0700X
Clinical Social Worker
C007564
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6112113
—
NC
Enumeration date
11/05/2009
Last updated
12/12/2011
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