Healthcare Provider Details

I. General information

NPI: 1831201003
Provider Name (Legal Business Name): PHILIP E PATE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S LOVDOVN STREET
WINCHESTER VA
22601
US

IV. Provider business mailing address

801 S LOVDOVN STREET
WINCHESTER VA
22601
US

V. Phone/Fax

Practice location:
  • Phone: 540-667-5431
  • Fax: 540-667-2855
Mailing address:
  • Phone: 540-667-5431
  • Fax: 540-667-2855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810002997
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number870
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: