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General NPI Number Information
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NPI Number | 1457500506
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Entity Type | Individual
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Provider Name | CARLA CROUCH TATE LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/13/2008
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Last Update Date | 01/17/2012
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Provider Practice Location Address
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Address Line | 519 LATHAM DR
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City | LOWELL
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State | AR
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Zip | 72745-8360
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Country | US
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Telephone | 479-750-0130
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Fax | 479-750-0937
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Provider Business Mailing Address
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Address Line | 519 LATHAM DR
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City | LOWELL
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State | AR
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Zip | 72745-8360
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Country | US
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Telephone | 479-750-0130
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Fax | 479-750-0937
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1332-C
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License Number State | AR
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