Healthcare Provider Details

I. General information

NPI: 1295452951
Provider Name (Legal Business Name): CAROLYN GURGANUS PATTERSON RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLYN BROOKE GURGANUS

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 EDWIN DR
VIRGINIA BEACH VA
23462-4522
US

IV. Provider business mailing address

500 SPINNAKER ST
ELIZABETH CITY NC
27909-6681
US

V. Phone/Fax

Practice location:
  • Phone: 757-301-2411
  • Fax:
Mailing address:
  • Phone: 252-331-9333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-240963
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: