Provider Demographics
NPI:1205685013
Name:PAIGE, ANDREA JAQUIS (MS)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:JAQUIS
Last Name:PAIGE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 EMERALD POINTE DR APT 2
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-7211
Mailing Address - Country:US
Mailing Address - Phone:334-530-0394
Mailing Address - Fax:
Practice Address - Street 1:2140 EMERALD POINTE DR APT 2
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-7211
Practice Address - Country:US
Practice Address - Phone:334-530-0394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty