Basic Information
| Provider Information | |||||||||
| NPI: | 1437378494 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAGE | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BA, CIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 218 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253031543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043445924 | ||||||||
| FaxNumber: | 3043443503 | ||||||||
| Practice Location | |||||||||
| Address1: | 2157 GREENBRIER ST | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253119623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043445924 | ||||||||
| FaxNumber: | 3043443503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2007 | ||||||||
| LastUpdateDate: | 08/08/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.