Provider Demographics
NPI:1356691299
Name:PAGE, CHRISTINE JEAN (LPC)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:JEAN
Last Name:PAGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 WATER PL SE
Mailing Address - Street 2:STE. 240
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2061
Mailing Address - Country:US
Mailing Address - Phone:678-799-4828
Mailing Address - Fax:770-693-0157
Practice Address - Street 1:1800 WATER PL SE
Practice Address - Street 2:STE. 240
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2061
Practice Address - Country:US
Practice Address - Phone:678-799-4828
Practice Address - Fax:770-693-0157
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC00693101YM0800X
GALPC006913101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator