Basic Information
| Provider Information | |||||||||
| NPI: | 1598071698 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAIGE | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3650 JOSEPH SIEWICK DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220331710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037161143 | ||||||||
| FaxNumber: | 7032649861 | ||||||||
| Practice Location | |||||||||
| Address1: | 3650 JOSEPH SIEWICK DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220331710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037161143 | ||||||||
| FaxNumber: | 7032649861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2010 | ||||||||
| LastUpdateDate: | 08/26/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 0701001076 | VA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.