Provider Demographics
NPI:1265773642
Name:GAGE, JUANITA (MA, CSAC)
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:GAGE
Suffix:
Gender:F
Credentials:MA, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-9517
Mailing Address - Country:US
Mailing Address - Phone:808-579-9584
Mailing Address - Fax:808-579-8902
Practice Address - Street 1:3555 BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-9517
Practice Address - Country:US
Practice Address - Phone:808-579-9584
Practice Address - Fax:808-579-8902
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)