Provider Demographics
NPI:1922698604
Name:PAGE, LETHA DAISY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LETHA
Middle Name:DAISY
Last Name:PAGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12973 CHETS CREEK DR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-7485
Mailing Address - Country:US
Mailing Address - Phone:904-580-4535
Mailing Address - Fax:
Practice Address - Street 1:8647 BAYPINE RD
Practice Address - Street 2:STE. 206
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7544
Practice Address - Country:US
Practice Address - Phone:904-490-6974
Practice Address - Fax:866-489-5550
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW189591041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical