Provider Demographics
NPI:1184954901
Name:LEPAGE, CHRISTOPHER D (LLP, LMSW, PSYD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:D
Last Name:LEPAGE
Suffix:
Gender:M
Credentials:LLP, LMSW, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4269
Mailing Address - Country:US
Mailing Address - Phone:231-348-3452
Mailing Address - Fax:231-348-3452
Practice Address - Street 1:319 E 20TH ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4269
Practice Address - Country:US
Practice Address - Phone:231-348-3452
Practice Address - Fax:231-348-3452
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010890661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical