Basic Information
| Provider Information | |||||||||
| NPI: | 1720510811 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAGE | ||||||||
| FirstName: | BRITTNEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13289 | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277093289 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1010 MARQUEZ PL | ||||||||
| Address2: | UNIT D | ||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875051693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5055018485 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2017 | ||||||||
| LastUpdateDate: | 01/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | NM | N | 221700000X | 19-329 | TN | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Art Therapist | 101YP2500X | A15556 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.