Individual
ANGELA D TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
815 N SPRING ST, HARRISON, AR 72601-2904
(870) 204-5697
Mailing address
PO BOX 1138, HARRISON, AR 72602-1138
(870) 204-5697
(870) 741-9812
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2038-C
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06070013800
QUALCHOICE
AR
01
—
5Y956
BLUE CROSS
AR
Enumeration date
05/19/2006
Last updated
02/09/2023
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