Individual
VIVIAN KELLER TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1403 43RD AVENUE, GULFPORT, MS 39501
(228) 897-7730
(228) 575-0886
Mailing address
P.O. BOX 7827, GULFPORT, MS 39506
(228) 897-7730
(228) 575-0886
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
2561
MS
1041C0700X
Clinical Social Worker
Primary
C2058
MS
Other
Enumeration date
03/28/2007
Last updated
09/22/2010
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