Provider Demographics
NPI:1225385735
Name:PAGE, CASSANDRA (PSYD)
Entity Type:Individual
Prefix:MISS
First Name:CASSANDRA
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 TRIPLE CROWN CIR
Mailing Address - Street 2:APT. 301
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3071
Mailing Address - Country:US
Mailing Address - Phone:909-938-1346
Mailing Address - Fax:
Practice Address - Street 1:4560 SOUTH BLVD
Practice Address - Street 2:300
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23542
Practice Address - Country:US
Practice Address - Phone:757-228-5635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005201103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical