Provider Demographics
NPI:1184654907
Name:PAIGE, BARBARA K
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:K
Last Name:PAIGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N LYNNHAVEN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7523
Mailing Address - Country:US
Mailing Address - Phone:757-486-6955
Mailing Address - Fax:757-486-3258
Practice Address - Street 1:101 N LYNNHAVEN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7523
Practice Address - Country:US
Practice Address - Phone:757-486-6955
Practice Address - Fax:757-486-3258
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000856103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA77-0115-2Medicaid
VA052857OtherANTHEM BCBS
VA052857OtherANTHEM BCBS