Provider Demographics
NPI:1851870315
Name:PACE MENTAL HEATLH
Entity Type:Organization
Organization Name:PACE MENTAL HEATLH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOBGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-302-9254
Mailing Address - Street 1:8348 TRAFORD LN STE 301
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1650
Mailing Address - Country:US
Mailing Address - Phone:571-350-3060
Mailing Address - Fax:757-561-2625
Practice Address - Street 1:8348 TRAFORD LN STE 301
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1650
Practice Address - Country:US
Practice Address - Phone:571-350-3060
Practice Address - Fax:757-561-2625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010431832084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic PsychiatryGroup - Multi-Specialty