Provider Demographics
NPI:1245582451
Name:MACE, MICHAEL EDWARD (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EDWARD
Last Name:MACE
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 111659
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98411-1659
Mailing Address - Country:US
Mailing Address - Phone:253-298-2007
Mailing Address - Fax:253-564-1211
Practice Address - Street 1:1206 S WOODLAWN ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465-2234
Practice Address - Country:US
Practice Address - Phone:253-298-2007
Practice Address - Fax:253-564-1211
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2016-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60247155101Y00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor