Provider Demographics
NPI:1376847673
Name:PAGE, KATHLEENGE ANN (M,A,)
Entity Type:Individual
Prefix:MS
First Name:KATHLEENGE
Middle Name:ANN
Last Name:PAGE
Suffix:
Gender:F
Credentials:M,A,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12484 SILENT WOLF DR.
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112
Mailing Address - Country:US
Mailing Address - Phone:571-425-5385
Mailing Address - Fax:
Practice Address - Street 1:12484 SILENT WOLF DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20112-7502
Practice Address - Country:US
Practice Address - Phone:571-425-5385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health