Provider Demographics
NPI:1336596733
Name:PAGE, VIRGINIA (LPC, MAC, CACII, NCC)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:LPC, MAC, CACII, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 48TH AVE N STE 202
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5425
Mailing Address - Country:US
Mailing Address - Phone:843-267-8885
Mailing Address - Fax:843-449-6851
Practice Address - Street 1:1203 48TH AVE N STE 202
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5425
Practice Address - Country:US
Practice Address - Phone:843-267-8885
Practice Address - Fax:843-449-6851
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5658101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional