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General NPI Number Information
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NPI Number | 1558156794
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Entity Type | Individual
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Provider Name | JERREN PATRICK TATE-SPENCER
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Gender | Male
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Dates
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Enumeration Date | 04/09/2025
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 1030 LOFTIS BLVD
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-2999
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Country | US
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Telephone | 757-720-0099
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Fax |
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Provider Business Mailing Address
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Address Line | 303 DOGWOOD RD
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City | YORKTOWN
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State | VA
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Zip | 23690-3930
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Country | US
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Telephone | 509-723-9767
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Fax | 509-723-9767
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-25-427030
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License Number State | VA
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