Healthcare Provider Details

I. General information

NPI: 1578329561
Provider Name (Legal Business Name): JOYCE PAIGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 02/27/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11531 GREEN HOLLY CV
FORT WAYNE IN
46845-2018
US

IV. Provider business mailing address

11531 GREEN HOLLY CV
FORT WAYNE IN
46845-2018
US

V. Phone/Fax

Practice location:
  • Phone: 260-348-6501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: