Provider Demographics
NPI:1235718842
Name:TATE, JULIE SUTTLES (LMSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:SUTTLES
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 1:4619 ENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-4663
Mailing Address - Country:US
Mailing Address - Phone:404-771-0178
Mailing Address - Fax:770-219-2664
Practice Address - Street 1:431 GREEN ST NW
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3349
Practice Address - Country:US
Practice Address - Phone:470-460-5582
Practice Address - Fax:877-684-1686
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW007868104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker