Provider Demographics
NPI:1508990102
Name:TATE, MARTHA M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:M
Last Name:TATE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 KIPLING DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-1637
Mailing Address - Country:US
Mailing Address - Phone:404-352-4045
Mailing Address - Fax:404-351-2548
Practice Address - Street 1:900 KIPLING DR NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-1637
Practice Address - Country:US
Practice Address - Phone:404-352-4045
Practice Address - Fax:404-351-2548
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical