Provider Demographics
NPI:1609052810
Name:TATE, KIM (MS, NCC, LAPC)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:MS, NCC, LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 BIRCH RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4606
Mailing Address - Country:US
Mailing Address - Phone:404-217-6308
Mailing Address - Fax:
Practice Address - Street 1:2900 CHAMBLEE TUCKER RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4100
Practice Address - Country:US
Practice Address - Phone:404-550-9151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC 005649101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)