Provider Demographics
NPI:1710312095
Name:TATE, CONTESA L (MA)
Entity Type:Individual
Prefix:
First Name:CONTESA
Middle Name:L
Last Name:TATE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CONTESA
Other - Middle Name:L
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFTI
Mailing Address - Street 1:200 24TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-1804
Mailing Address - Country:US
Mailing Address - Phone:510-412-9200
Mailing Address - Fax:
Practice Address - Street 1:200 24TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-1804
Practice Address - Country:US
Practice Address - Phone:510-412-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA88991390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health