Provider Demographics
NPI:1831142785
Name:TATE, ANGELA D (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:TATE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:VICTORIA
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1138
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72602-1138
Mailing Address - Country:US
Mailing Address - Phone:870-204-5697
Mailing Address - Fax:870-741-9812
Practice Address - Street 1:815 N SPRING ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2904
Practice Address - Country:US
Practice Address - Phone:870-204-5697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2038-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR06070013800OtherQUALCHOICE
AR5Y956OtherBLUE CROSS
AR06070013800OtherQUALCHOICE