Healthcare Provider Details

I. General information

NPI: 1356696819
Provider Name (Legal Business Name): MR. KARL A PAIGE SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 GARRISON BLVD STE 150
BALTIMORE MD
21216-2316
US

IV. Provider business mailing address

2300 GARRISON BLVD STE 150
BALTIMORE MD
21216-2316
US

V. Phone/Fax

Practice location:
  • Phone: 410-233-3111
  • Fax: 410-233-3222
Mailing address:
  • Phone: 410-233-3111
  • Fax: 410-233-3222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC4418
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: