Provider Demographics
NPI:1437378494
Name:PAGE, JASON WILLIAM (BA, CIS)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:WILLIAM
Last Name:PAGE
Suffix:
Gender:M
Credentials:BA, CIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-1543
Mailing Address - Country:US
Mailing Address - Phone:304-344-5924
Mailing Address - Fax:304-344-3503
Practice Address - Street 1:2157 GREENBRIER ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-9623
Practice Address - Country:US
Practice Address - Phone:304-344-5924
Practice Address - Fax:304-344-3503
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)