Provider Demographics
NPI:1588155659
Name:PAIGE, SHARNITA TRICE (BS, SST)
Entity type:Individual
Prefix:MRS
First Name:SHARNITA
Middle Name:TRICE
Last Name:PAIGE
Suffix:
Gender:F
Credentials:BS, SST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 KIRTS BLVD STE 231
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4156
Mailing Address - Country:US
Mailing Address - Phone:248-953-6786
Mailing Address - Fax:
Practice Address - Street 1:570 KIRTS BLVD STE 231
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4156
Practice Address - Country:US
Practice Address - Phone:248-953-6786
Practice Address - Fax:248-824-7349
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803087002104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6803087002Medicaid