# LAKE LINGANORE PSYCHIATRY, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720864945
- **Authorized official:** MARIE SHEILA TATE PMHNP (MANAGER)
- **Authorized official phone:** (240) 405-8084

## Contact information

- **Practice address:** 617 W PATRICK ST STE 223, FREDERICK, MD 21701-4027
- **Practice address phone:** (240) 405-8084
- **Mailing address:** 201 E PATRICK ST, FREDERICK, MD 21705-7501
- **Mailing address phone:** (240) 405-8084

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 09/04/2023
- **Last updated:** 06/11/2024