Healthcare Provider Details

I. General information

NPI: 1255267381
Provider Name (Legal Business Name): ROY PAGE LCAS-A, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9255 FAWN LAKE DR
RALEIGH NC
27617-7444
US

IV. Provider business mailing address

9255 FAWN LAKE DR
RALEIGH NC
27617-7444
US

V. Phone/Fax

Practice location:
  • Phone: 405-818-4230
  • Fax:
Mailing address:
  • Phone: 405-818-4230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-27577
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: