MEDICARE: PAIGE BEACH GONZALEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1861019572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAIGE BEACH GONZALEZ

Provider Business Mailing Address
First Line	:	5748 ORCUTT LN
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-4627
Country	:	US
Telephone Number	:	804-381-8566
Fax Number	:

Provider Business Practice Location Address
First Line	:	2320 BROAD ROCK BLVD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-4812
Country	:	US
Telephone Number	:	804-276-6767
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2020
Last Update Date	:	06/29/2020

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Directions to “ PAIGE BEACH GONZALEZ ” Practice Location

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