Healthcare Provider Details

I. General information

NPI: 1316663255
Provider Name (Legal Business Name): PAIGE ALEYSIA CLAIRE GOLDBACH LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 ANCHOR CREEK WAY
HOLLY SPRINGS NC
27540
US

IV. Provider business mailing address

513 ANCHOR CREEK WAY
HOLLY SPRINGS NC
27540
US

V. Phone/Fax

Practice location:
  • Phone: 717-341-4292
  • Fax:
Mailing address:
  • Phone: 717-341-4292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP018353
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: