Individual
MRS. AUDREY JEAN TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, AT, CDCA
Contact information
Practice address
347 MIDWAY BLVD, SUITE 200, ELYRIA, OH 44035-9006
(440) 324-5701
(440) 324-9978
Mailing address
17852 CANNON AVE # UP, LAKEWOOD, OH 44107-2206
(216) 501-0799
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
C 1300788
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
151783
OH
Other
Enumeration date
02/21/2016
Last updated
02/21/2016
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