Individual
JESSICA G. TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRC, LCAS, LPC, MAC
Contact information
Practice address
501 PALADIN DR, GREENVILLE, NC 27834-7826
(252) 353-5346
(252) 321-7300
Mailing address
4238 DUDLEYS GRANT DR APT C, WINTERVILLE, NC 28590-7942
(252) 702-7503
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2062
NC
101YP2500X
Professional Counselor
10900
NC
101YP2500X
Professional Counselor
168173
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10900
LPC
NC
01
—
2062
LCAS
NC
Enumeration date
11/04/2011
Last updated
06/30/2016
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