Individual
TINA TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
109A PILGRIM RD, GREENVILLE, SC 29607-5702
(864) 612-0219
Mailing address
109A PILGRIM RD, GREENVILLE, SC 29607-5702
(864) 612-0219
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IHCP-1339
DHEC
SC
Enumeration date
12/15/2020
Last updated
12/15/2020
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