Provider Demographics
NPI:1003543273
Name:PACE, CAROLINE (LMHC)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:PACE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5637 NW COVENTRY CIR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-4056
Mailing Address - Country:US
Mailing Address - Phone:561-201-3302
Mailing Address - Fax:
Practice Address - Street 1:111 ORANGE AVE # M-205
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4304
Practice Address - Country:US
Practice Address - Phone:772-207-1095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-06
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21010101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health