Provider Demographics
NPI:1639300064
Name:PACE, PATSY (LPC, LADAC)
Entity Type:Individual
Prefix:MRS
First Name:PATSY
Middle Name:
Last Name:PACE
Suffix:
Gender:F
Credentials:LPC, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 20301
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71612
Mailing Address - Country:US
Mailing Address - Phone:870-293-4478
Mailing Address - Fax:870-293-4478
Practice Address - Street 1:1116 S STATE ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-5851
Practice Address - Country:US
Practice Address - Phone:870-293-4478
Practice Address - Fax:469-259-1760
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
AR256L101YA0400X
P1612194101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)