Provider Demographics
NPI:1457946840
Name:TATE, JOSAPHINA
Entity Type:Individual
Prefix:
First Name:JOSAPHINA
Middle Name:
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 1:1642 VILLAGE BROOK DR APT B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8614
Mailing Address - Country:US
Mailing Address - Phone:910-987-4230
Mailing Address - Fax:
Practice Address - Street 1:10130 MALLARD CREEK RD STE 371
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-6000
Practice Address - Country:US
Practice Address - Phone:704-612-0566
Practice Address - Fax:704-498-4846
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health