MEDICARE: PAIGE HENNIS LPC-0701008497

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0701008497	VA

General Provider Information

NPI Number	:	1336543032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAIGE HENNIS LPC-0701008497

Provider Business Mailing Address
First Line	:	10001 DALMATION DR
Second Line	:
City	:	CHARLES CITY
State	:	VA
Zip	:	23030-3404
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10001 DALMATION DR
Second Line	:
City	:	CHARLES CITY
State	:	VA
Zip	:	23030-3404
Country	:	US
Telephone Number	:	720-276-8219
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2014
Last Update Date	:	12/22/2023

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