Provider Demographics
NPI:1063544328
Name:PAGE, PRESTON HENRY (LCSW, LSATP)
Entity type:Individual
Prefix:MR
First Name:PRESTON
Middle Name:HENRY
Last Name:PAGE
Suffix:
Gender:M
Credentials:LCSW, LSATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 F STARLING AVENUE
Mailing Address - Street 2:POB 333
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24114
Mailing Address - Country:US
Mailing Address - Phone:276-734-9870
Mailing Address - Fax:276-666-2332
Practice Address - Street 1:900 F STARLING AVENUE
Practice Address - Street 2:POB 333
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24114
Practice Address - Country:US
Practice Address - Phone:276-734-9870
Practice Address - Fax:276-666-2332
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040048291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical