Provider Demographics
NPI:1942246764
Name:PATE-CAROLAN, LIA MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LIA
Middle Name:MARIE
Last Name:PATE-CAROLAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:LIA
Other - Middle Name:MARIE
Other - Last Name:PATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3141 JOHN HUMPHRIES WYND
Mailing Address - Street 2:SUITE 275
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5438
Mailing Address - Country:US
Mailing Address - Phone:919-783-5431
Mailing Address - Fax:919-783-6480
Practice Address - Street 1:3141 JOHN HUMPHRIES WYND
Practice Address - Street 2:SUITE 275
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5438
Practice Address - Country:US
Practice Address - Phone:919-783-5431
Practice Address - Fax:919-783-6480
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3230103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000896Medicaid
NC046XCOtherBLUE CROSS BLUE SHIELD
2823104Medicare PIN
NC046XCOtherBLUE CROSS BLUE SHIELD