Provider Demographics
NPI:1821069782
Name:PAGE, CYNTHIA (APC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 MERIWEATHER DR
Mailing Address - Street 2:STE 102
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-3046
Mailing Address - Country:US
Mailing Address - Phone:706-227-7204
Mailing Address - Fax:706-227-7225
Practice Address - Street 1:250 NORTH AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-2244
Practice Address - Country:US
Practice Address - Phone:706-542-9739
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC000899101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor