Provider Demographics
NPI:1457830317
Name:MACE, CHRISTOPHER H (PHD, MEPP, MED)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:H
Last Name:MACE
Suffix:
Gender:M
Credentials:PHD, MEPP, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5680 KING CENTRE DR STE 600
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5755
Mailing Address - Country:US
Mailing Address - Phone:024-760-0222
Mailing Address - Fax:202-217-2330
Practice Address - Street 1:5680 KING CENTRE DR STE 600
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5755
Practice Address - Country:US
Practice Address - Phone:202-476-0022
Practice Address - Fax:202-217-2330
Is Sole Proprietor?:No
Enumeration Date:2018-08-11
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA009335804I103TP0814X, 103G00000X
171000000X
DCNIH-USA174H00000X
GABH23885103G00000X
DC103T00000X
MD103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No171000000XOther Service ProvidersMilitary Health Care Provider
No174H00000XOther Service ProvidersHealth Educator
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1457830317Medicaid
009335804IOtherNATIONAL INSTITUTE OF HEALTH CLINICAL PROVIDER
VA1457830317Medicaid
MD1457830317Medicaid
FL1457830317Medicaid
GA1457830317Medicaid
VA327650OtherAMERICAN ACADEMY OF NEUROLOGY