Provider Demographics
NPI:1467148551
Name:WELLMAN, PAIGE ALEXANDRA (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:ALEXANDRA
Last Name:WELLMAN
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:ALEXANDRA
Other - Last Name:BALDWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1618 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-1451
Mailing Address - Country:US
Mailing Address - Phone:217-242-9786
Mailing Address - Fax:
Practice Address - Street 1:822 STATE ST # 9
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4961
Practice Address - Country:US
Practice Address - Phone:217-231-1413
Practice Address - Fax:217-919-9401
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.019002101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional