Provider Demographics
NPI:1982489753
Name:PAGE, TAJA MONEE (LCSW-S)
Entity Type:Individual
Prefix:
First Name:TAJA
Middle Name:MONEE
Last Name:PAGE
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:TAJA
Other - Middle Name:MONEE
Other - Last Name:PAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-S
Mailing Address - Street 1:520 W 14TH ST APT 314
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-2154
Mailing Address - Country:US
Mailing Address - Phone:757-685-9629
Mailing Address - Fax:
Practice Address - Street 1:520 W 14TH ST APT 314
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-2154
Practice Address - Country:US
Practice Address - Phone:757-685-9629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09060112951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical