Provider Demographics
NPI:1851263784
Name:TATE, LASHUNDRA REENISE (ALC)
Entity type:Individual
Prefix:
First Name:LASHUNDRA
Middle Name:REENISE
Last Name:TATE
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 164
Mailing Address - Street 2:
Mailing Address - City:SHORTER
Mailing Address - State:AL
Mailing Address - Zip Code:36075-0164
Mailing Address - Country:US
Mailing Address - Phone:334-300-0131
Mailing Address - Fax:
Practice Address - Street 1:1785 TALIAFERRO TRL STE 13
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7758
Practice Address - Country:US
Practice Address - Phone:334-300-0131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-19
Last Update Date:2025-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04520101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health