Provider Demographics
NPI:1912617234
Name:LEPAGE, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:LEPAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25234 FAIRFAX RD
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-8281
Mailing Address - Country:US
Mailing Address - Phone:949-375-7744
Mailing Address - Fax:
Practice Address - Street 1:25234 FAIRFAX RD
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-8281
Practice Address - Country:US
Practice Address - Phone:949-375-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6821104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker