Provider Demographics
NPI:1912441452
Name:DUBOIS, PATE ALAN (MS)
Entity Type:Individual
Prefix:MR
First Name:PATE
Middle Name:ALAN
Last Name:DUBOIS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:MR
Other - First Name:PATRICK
Other - Middle Name:ALAN
Other - Last Name:DUBOIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:1 S 2ND ST FL 1
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3088
Mailing Address - Country:US
Mailing Address - Phone:570-628-6990
Mailing Address - Fax:570-628-5899
Practice Address - Street 1:1 S 2ND ST FL 1
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3088
Practice Address - Country:US
Practice Address - Phone:570-628-6990
Practice Address - Fax:570-628-5899
Is Sole Proprietor?:No
Enumeration Date:2016-12-16
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF89165106H00000X
CAAMFT127740106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist