Provider Demographics
NPI:1770500340
Name:TATE, MARY VICTORIA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:VICTORIA
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 1:1309 S. LINDEN
Mailing Address - Street 2:SUITE C
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532
Mailing Address - Country:US
Mailing Address - Phone:810-630-1152
Mailing Address - Fax:810-630-9107
Practice Address - Street 1:1309 S. LINDEN
Practice Address - Street 2:SUITE C
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532
Practice Address - Country:US
Practice Address - Phone:810-630-1152
Practice Address - Fax:810-630-9107
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010594411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical