Provider Demographics
NPI:1083979231
Name:TATE, SAFIYA (LMSW)
Entity Type:Individual
Prefix:
First Name:SAFIYA
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3917 GONZALES AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-5768
Mailing Address - Country:US
Mailing Address - Phone:864-483-2992
Mailing Address - Fax:864-757-9209
Practice Address - Street 1:3917 GONZALES AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-5768
Practice Address - Country:US
Practice Address - Phone:864-483-2992
Practice Address - Fax:864-757-9209
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC94221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical