Provider Demographics
NPI:1790462158
Name:PACE, ALLISON MARIE HAMILTON (APC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE HAMILTON
Last Name:PACE
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 LOVELL RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-4241
Mailing Address - Country:US
Mailing Address - Phone:912-655-4940
Mailing Address - Fax:
Practice Address - Street 1:445 HUNTINGTON RD STE 110
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-1840
Practice Address - Country:US
Practice Address - Phone:770-246-2822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008527101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional