Provider Demographics
NPI:1780238030
Name:PATE, GARY B JR (PHD, HSP-P, BCBA-D)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:B
Last Name:PATE
Suffix:JR
Gender:M
Credentials:PHD, HSP-P, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4187 ABBINGTON TER
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5578
Mailing Address - Country:US
Mailing Address - Phone:910-990-1842
Mailing Address - Fax:252-565-4505
Practice Address - Street 1:4187 ABBINGTON TER
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5578
Practice Address - Country:US
Practice Address - Phone:910-990-1842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-19-35125103K00000X
NC5807103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst