Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 178011941 | IL |
NPI | 1003382623 |
---|---|
Provider Name | Dina Tate |
First Address | Chicago, IL 60604-4137 |
Second Address | Aurora, IL 60506-2447 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2018 |
Last Update Date | 22/10/2018 |