Provider Demographics
NPI:1457617342
Name:TATE, LESLIE NEVINS (MED, LPC, MAC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:NEVINS
Last Name:TATE
Suffix:
Gender:F
Credentials:MED, LPC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 FARRAR LN
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-2632
Mailing Address - Country:US
Mailing Address - Phone:864-382-1515
Mailing Address - Fax:
Practice Address - Street 1:404 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671-2608
Practice Address - Country:US
Practice Address - Phone:864-380-4403
Practice Address - Fax:864-380-4403
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC508958101YA0400X
SC1411259101YA0400X
SC5562101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)