Individual provider Active NPI

George Nelson Gates, D.MIN. LPC

  • Professional Counselor
  • Wilmington, NC
National Provider Identifier
1073552600
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
3187 Issued in NC
Practice address
1717 Shipyard Blvd
Suite 210
Wilmington, NC 28403-8019
Phone
(910) 392-7877
Fax
(910) 392-7886
NPI assigned
Jun 6, 2006
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 3187 NC Primary
Clinical Psychologist 103TC0700X 2291 NC

Addresses

Primary practice location

1717 Shipyard Blvd
Suite 210
Wilmington, NC 28403-8019

Mailing address

4017 Chandler Dr
Wilmington, NC 28405-6423
Phone (910) 512-6004

Other identifiers 1

IdentifierTypeStateIssuer
6107228MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
2291NCMDAddiction (Substance Use Disorder) Counselor
3187NCMDChiropractor

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22201/brand/1/csg/1/fhir/r4

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1073552600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4017 CHANDLER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284056423",
            "telephone_number": "910-512-6004",
            "fax_number": "910-392-7886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 SHIPYARD BLVD",
            "address_2": "SUITE 210",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284038019",
            "telephone_number": "910-392-7877",
            "fax_number": "910-392-7886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GATES",
        "first_name": "GEORGE",
        "middle_name": "NELSON",
        "name_prefix": "Dr.",
        "credential": "D.MIN. LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "3187",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "2291",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6107228",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.