Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003268533 |
---|---|
Provider Name | Ivie Page |
First Address | Hinesville, GA 31313-9439 |
Second Address | Hinesville, GA 31313-9439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2016 |
Last Update Date | 20/05/2021 |