Individual
MARINA ROSE PATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10700 MEDLOCK BRIDGE RD STE 101, JOHNS CREEK, GA 30097-8455
(404) 282-1196
Mailing address
1880 MAPLE DR APT 1136, KENNESAW, GA 30144-1743
(706) 223-8847
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC016718
GA
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26-4503737
—
GA
Enumeration date
12/19/2022
Last updated
04/22/2026
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