Healthcare Provider Details

I. General information

NPI: 1821897588
Provider Name (Legal Business Name): NIA PAGE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2581 HUNTCLIFF LN
PANAMA CITY FL
32405-4902
US

IV. Provider business mailing address

1627 LOOKOUT LANDING CIR
WINTER PARK FL
32789-5942
US

V. Phone/Fax

Practice location:
  • Phone: 850-520-3321
  • Fax:
Mailing address:
  • Phone: 321-217-2119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number25339
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: