Provider Demographics
NPI:1952942617
Name:CHASTAIN, PAIGE ANNE (CADC(CA&NV))
Entity Type:Individual
Prefix:MS
First Name:PAIGE
Middle Name:ANNE
Last Name:CHASTAIN
Suffix:
Gender:F
Credentials:CADC(CA&NV)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7818 TAY RIVER COURT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166
Mailing Address - Country:US
Mailing Address - Phone:802-829-3505
Mailing Address - Fax:
Practice Address - Street 1:7818 TAY RIVER COURT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166
Practice Address - Country:US
Practice Address - Phone:702-608-9491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI21450218101YA0400X
NV06674-C101YA0400X
CACICA03380520101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty