Basic Information
| Provider Information | |||||||||
| NPI: | 1912211640 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAGE | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | NEACE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | EDD, NCP, LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2525 CHARLESTOWN ROAD | ||||||||
| Address2: | FAIRMONT NEIGHBORHOOD CENTER | ||||||||
| City: | NEW ALBANY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025482051 | ||||||||
| FaxNumber: | 8129415239 | ||||||||
| Practice Location | |||||||||
| Address1: | 2525 CHARLESTOWN RD | ||||||||
| Address2: | FAIRMONT NEIGHBORHOOD CENTER | ||||||||
| City: | NEW ALBANY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471502556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025482051 | ||||||||
| FaxNumber: | 8129415239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2010 | ||||||||
| LastUpdateDate: | 08/05/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 39000847A | IN | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.