Healthcare Provider Details

I. General information

NPI: 1023550746
Provider Name (Legal Business Name): ALLISON TATE PASTINE LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2016
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 RITCHIE HWY
GLEN BURNIE MD
21061-3101
US

IV. Provider business mailing address

642 THOMAS WAY
SEVERNA PARK MD
21146-2832
US

V. Phone/Fax

Practice location:
  • Phone: 443-250-6653
  • Fax: 410-740-8068
Mailing address:
  • Phone: 443-250-6653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC3061
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC3061
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: