Provider Demographics
NPI:1922209550
Name:GAGE, STEVEN DAVID (MA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:DAVID
Last Name:GAGE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5613 DURALEIGH RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2694
Mailing Address - Country:US
Mailing Address - Phone:919-782-4597
Mailing Address - Fax:919-784-0089
Practice Address - Street 1:5613 DURALEIGH RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2694
Practice Address - Country:US
Practice Address - Phone:919-782-4597
Practice Address - Fax:919-784-0089
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC294106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105029Medicaid