Provider Demographics
NPI:1659393221
Name:PAGE, LISA K (LPC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:K
Last Name:PAGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:K
Other - Last Name:PAGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 2161
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870
Mailing Address - Country:US
Mailing Address - Phone:252-537-6164
Mailing Address - Fax:252-537-9199
Practice Address - Street 1:600 JACKSON ST
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870
Practice Address - Country:US
Practice Address - Phone:252-537-6164
Practice Address - Fax:252-537-9199
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4989101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103152Medicaid