Doctor Name: | MIKKI S PAGE |
NPI Number: | 1013058494 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 3984 |
Business Practice Address: | 112 Sartin Dr. Edmonton, KY - 42129 |
Business Phone Number: | 2704324951 |
Business Fax Number: | 2704325054 |
Mailing Address: | 112 Sartin Dr, EDMONTON |
State: | KY |
Postal Code: | 421298170 |
Phone Number: | 2709015000 |
Fax Number: | 2708425268 |
NPI Enumeration Date: | 02/09/2007 |
NPI Last Update Date: | 01/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 3984 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |