Provider Demographics
NPI:1083352710
Name:PAIGE, JODECI (LCMHCA)
Entity Type:Individual
Prefix:MISS
First Name:JODECI
Middle Name:
Last Name:PAIGE
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3161 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344-7936
Mailing Address - Country:US
Mailing Address - Phone:919-867-7771
Mailing Address - Fax:
Practice Address - Street 1:3161 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-7936
Practice Address - Country:US
Practice Address - Phone:919-548-5365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17579101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional