Provider Demographics
NPI:1013374347
Name:CARRIE VIRGINIA PATE THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:CARRIE VIRGINIA PATE THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:V
Authorized Official - Last Name:PATE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:228-990-8980
Mailing Address - Street 1:2112 BIENVILLE BLVD
Mailing Address - Street 2:SUITE L-1
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3052
Mailing Address - Country:US
Mailing Address - Phone:228-215-1744
Mailing Address - Fax:228-215-1721
Practice Address - Street 1:2112 BIENVILLE BLVD
Practice Address - Street 2:SUITE L-1
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3052
Practice Address - Country:US
Practice Address - Phone:228-990-8980
Practice Address - Fax:228-215-1721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-17
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC68901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty