Provider Demographics
NPI:1154994002
Name:PAIGE, BETHANY G (RMHCI)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:G
Last Name:PAIGE
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 S 14TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-4718
Mailing Address - Country:US
Mailing Address - Phone:978-403-0497
Mailing Address - Fax:
Practice Address - Street 1:1890 S 14TH ST STE 110
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4718
Practice Address - Country:US
Practice Address - Phone:978-403-0497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health