MEDICARE: PAIGE O'BRIEN COUNSELING LLC

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	251S00000X	Community/Behavioral Health Agency
2	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841707239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIGE O'BRIEN COUNSELING LLC

Provider Business Mailing Address
First Line	:	16749 BORDER RIDGE LN
Second Line	:
City	:	MONTPELIER
State	:	VA
Zip	:	23192-2065
Country	:	US
Telephone Number	:	804-240-6716
Fax Number	:

Provider Business Practice Location Address
First Line	:	6411 HORSEPEN RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-2905
Country	:	US
Telephone Number	:	804-240-6716
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	PAIGE O'BRIEN
Credential	:	LCSW
Telephone Number	:	804-240-6716

Provider Enumeration Date	:	01/07/2018
Last Update Date	:	03/17/2018

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