Provider Demographics
NPI:1073552600
Name:GATES, GEORGE NELSON (DMIN LPC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:NELSON
Last Name:GATES
Suffix:
Gender:M
Credentials:DMIN LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4017 CHANDLER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-6423
Mailing Address - Country:US
Mailing Address - Phone:910-512-6004
Mailing Address - Fax:910-392-7886
Practice Address - Street 1:1717 SHIPYARD BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8019
Practice Address - Country:US
Practice Address - Phone:910-392-7877
Practice Address - Fax:910-392-7886
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3187101YP2500X
NC2291103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107228Medicaid