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General NPI Number Information
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NPI Number | 1285966564
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Entity Type | Organization
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Legal Business Name | G.A.T. PSYCHOLOGICAL ASSOCIATES, PA
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Dates
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Enumeration Date | 02/11/2010
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Last Update Date | 07/09/2010
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Provider Practice Location Address
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Address Line | 307 COLERIDGE DR
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City | DUNN
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State | NC
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Zip | 28334-4408
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Country | US
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Telephone | 910-893-1649
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 23
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City | BUIES CREEK
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State | NC
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Zip | 27506-0023
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Country | US
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Telephone | 910-893-1649
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GARY A TAYLOR
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Credential | PH.D
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Telephone | 910-893-1649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1212
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License Number State | NC
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