VIVIAN KELLER TATE

GULFPORT, MS
NPI1063531663
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy1041C0700X Social Worker, Clinical
(Licence: MS  C2058)
Additional Taxonomies1041C0700X Social Worker, Clinical
(Licence: MS  2561)
Enumeration Date2007-03-28
Last Update Date2010-09-22
Business Address
-- VIVIAN KELLER TATE LCSW
1403 43RD AVENUE
GULFPORT, MS 39501
Phone number: 228-897-7730
Mailing Address
-- VIVIAN KELLER TATE LCSW
P.O. BOX 7827
GULFPORT, MS 39506
Phone number: 228-897-7730