Provider Demographics
NPI:1083581292
Name:PAIGE, LAQUAN EUGENE
Entity type:Individual
Prefix:
First Name:LAQUAN
Middle Name:EUGENE
Last Name:PAIGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5357 NEW CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1953
Mailing Address - Country:US
Mailing Address - Phone:910-795-8037
Mailing Address - Fax:
Practice Address - Street 1:5357 NEW CENTRE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1953
Practice Address - Country:US
Practice Address - Phone:910-795-8037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-22
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21140101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health