Provider Demographics
NPI:1184258519
Name:TATE, HADASSAH STAR
Entity type:Individual
Prefix:
First Name:HADASSAH
Middle Name:STAR
Last Name:TATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 HAMMOND DR STE G
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5062
Mailing Address - Country:US
Mailing Address - Phone:678-919-9095
Mailing Address - Fax:
Practice Address - Street 1:270 CARPENTER DR STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4946
Practice Address - Country:US
Practice Address - Phone:678-919-9095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty