Provider Demographics
NPI:1508089251
Name:LEPAGE, TINA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:LEPAGE
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 1:1703 LEGION RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-2359
Mailing Address - Country:US
Mailing Address - Phone:919-933-5355
Mailing Address - Fax:919-929-3227
Practice Address - Street 1:1703 LEGION RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-2359
Practice Address - Country:US
Practice Address - Phone:919-933-5355
Practice Address - Fax:919-929-3227
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2865103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000832Medicaid