Provider Demographics
NPI:1881309599
Name:PAIGE, KIMBERLEE TAYLOR HARTZOG (LMHP-R)
Entity type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:TAYLOR HARTZOG
Last Name:PAIGE
Suffix:
Gender:F
Credentials:LMHP-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14347 MICHAUX VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-3704
Mailing Address - Country:US
Mailing Address - Phone:704-662-4849
Mailing Address - Fax:
Practice Address - Street 1:11901 REEDY BRANCH RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23838-4235
Practice Address - Country:US
Practice Address - Phone:704-662-4849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health