=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851263784
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LASHUNDRA REENISE TATE ALC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2025
-----------------------------------------------------
Last Update Date | 09/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1785 TALIAFERRO TRL STE 13
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36117-7758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-300-0131
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 164
-----------------------------------------------------
City | SHORTER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36075-0164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-300-0131
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | ALC04520
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------