Provider Demographics
NPI:1255833182
Name:PACE, TIMOTHY (LPC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:PACE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13926 HULL STREET RD # 2025
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2004
Mailing Address - Country:US
Mailing Address - Phone:804-464-8420
Mailing Address - Fax:
Practice Address - Street 1:221 RUTHERS RD STE 101
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5395
Practice Address - Country:US
Practice Address - Phone:804-497-9418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X
VA0701009973101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No172A00000XOther Service ProvidersDriver