Individual
JESSE JAMES TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
610 VARSITY DR, WILMINGTON, NC 28403-8444
(910) 520-2921
Mailing address
610 VARSITY DR, WILMINGTON, NC 28403-8444
(910) 520-2921
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/10/2009
Last updated
09/10/2009
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