Healthcare Provider Details

I. General information

NPI: 1457224073
Provider Name (Legal Business Name): LATOYA CELESTE TATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BRUSHY FORK DR
GREENSBORO NC
27406-8059
US

IV. Provider business mailing address

5103 MALLISON WAY
MC LEANSVILLE NC
27301-9004
US

V. Phone/Fax

Practice location:
  • Phone: 336-303-6922
  • Fax:
Mailing address:
  • Phone: 336-303-6922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: