Healthcare Provider Details

I. General information

NPI: 1780238030
Provider Name (Legal Business Name): GARY B PATE JR. PHD, HSP-P, BCBA-D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4187 ABBINGTON TER
WILMINGTON NC
28403-5578
US

IV. Provider business mailing address

4187 ABBINGTON TER
WILMINGTON NC
28403-5578
US

V. Phone/Fax

Practice location:
  • Phone: 910-990-1842
  • Fax:
Mailing address:
  • Phone: 910-990-1842
  • Fax: 252-565-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5807
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-35125
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: