Provider Demographics
NPI:1497520084
Name:TATE, CHRISTIAN M
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:M
Last Name:TATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7014 SMITH CORNERS BLVD # 1198
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-3793
Mailing Address - Country:US
Mailing Address - Phone:636-395-0184
Mailing Address - Fax:
Practice Address - Street 1:3111 SPRINGBANK LN STE I
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3373
Practice Address - Country:US
Practice Address - Phone:704-325-5881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-24
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0191291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical