Provider Demographics
NPI:1912211640
Name:PAGE, MICHELE NEACE (EDD, NCP, LMHC)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:NEACE
Last Name:PAGE
Suffix:
Gender:F
Credentials:EDD, NCP, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 CHARLESTOWN ROAD
Mailing Address - Street 2:FAIRMONT NEIGHBORHOOD CENTER
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150
Mailing Address - Country:US
Mailing Address - Phone:502-548-2051
Mailing Address - Fax:812-941-5239
Practice Address - Street 1:2525 CHARLESTOWN RD
Practice Address - Street 2:FAIRMONT NEIGHBORHOOD CENTER
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2556
Practice Address - Country:US
Practice Address - Phone:502-548-2051
Practice Address - Fax:812-941-5239
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000847A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health