Provider Demographics
NPI:1922630474
Name:PAIGE, DORESCIA RACHELLE (LPC)
Entity Type:Individual
Prefix:
First Name:DORESCIA
Middle Name:RACHELLE
Last Name:PAIGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 WILSON DR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-4580
Mailing Address - Country:US
Mailing Address - Phone:757-256-8743
Mailing Address - Fax:
Practice Address - Street 1:4453 SHORE DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-2821
Practice Address - Country:US
Practice Address - Phone:757-231-6343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008932101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health