Vivian Keller Tate, LCSW
Social Worker, Clinical in Gulfport, MS. Individual provider (NPI-1).
NPI number1063531663
StatusActive
Last updated in NPPESSep 22, 2010
Details
- NPI
- 1063531663
- Entity type
- Individual (NPI-1)
- Name
- Vivian Keller Tate
- Credential
- LCSW
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Mar 28, 2007
- Last updated
- Sep 22, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | C2058 | MS | Yes |
| 1041C0700X | Social Worker, Clinical | 2561 | MS |
Practice location
1403 43rd AvenueGulfport, MS 39501
Phone 228-897-7730 · Fax 228-575-0886
Mailing address
P.O. Box 7827Gulfport, MS 39506
Phone 228-897-7730 · Fax 228-575-0886
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