Provider Demographics
NPI:1932821618
Name:PACE, CHANITA MARIE (LPC, LICDC)
Entity Type:Individual
Prefix:
First Name:CHANITA
Middle Name:MARIE
Last Name:PACE
Suffix:
Gender:F
Credentials:LPC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 ROCKY FORK BLVD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-5306
Mailing Address - Country:US
Mailing Address - Phone:614-705-3511
Mailing Address - Fax:
Practice Address - Street 1:596 ROCKY FORK BLVD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-5306
Practice Address - Country:US
Practice Address - Phone:614-705-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161775101YA0400X
OHC.2103701101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)