Basic Information
| Provider Information | |||||||||
| NPI: | 1629601893 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAICE | ||||||||
| FirstName: | ALEXIS | ||||||||
| MiddleName: | LAUREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 533 EDMONTON TER NE | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201761822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5712711763 | ||||||||
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| Practice Location | |||||||||
| Address1: | 401 GRAFTON LN | ||||||||
| Address2: | |||||||||
| City: | BERRYVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226112577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409552400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2020 | ||||||||
| LastUpdateDate: | 02/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.