Provider Demographics
NPI:1104980887
Name:TATE, LYNDA F (LISW CP)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:F
Last Name:TATE
Suffix:
Gender:F
Credentials:LISW CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 PELHAM RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615
Mailing Address - Country:US
Mailing Address - Phone:864-234-6778
Mailing Address - Fax:
Practice Address - Street 1:3519 PELHAM RD
Practice Address - Street 2:SUITE 103
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615
Practice Address - Country:US
Practice Address - Phone:864-234-6778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC62281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical