Provider Demographics
NPI:1679333207
Name:WHITE, PAIGE RENEE (PPS)
Entity Type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:RENEE
Last Name:WHITE
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 GARDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95633-9261
Mailing Address - Country:US
Mailing Address - Phone:530-333-8330
Mailing Address - Fax:
Practice Address - Street 1:5101 GARDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:GARDEN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95633-9261
Practice Address - Country:US
Practice Address - Phone:530-333-8330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool