Healthcare Provider Details

I. General information

NPI: 1669977732
Provider Name (Legal Business Name): LEPAGE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5842 FAYETTEVILLE ROAD SUITE 106
DURHAM NC
27713
US

IV. Provider business mailing address

5842 FAYETTEVILLE ROAD SUITE 106
DURHAM NC
27713
US

V. Phone/Fax

Practice location:
  • Phone: 919-572-0000
  • Fax: 919-572-9999
Mailing address:
  • Phone: 919-572-0000
  • Fax: 919-572-9999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. TINA LEPAGE
Title or Position: PRACTICE OWNER
Credential: PSY.D.
Phone: 919-572-0000