Provider Demographics
NPI:1982755054
Name:DEPACE, A. NICHOLAS (PHD)
Entity Type:Individual
Prefix:
First Name:A. NICHOLAS
Middle Name:
Last Name:DEPACE
Suffix:
Gender:M
Credentials:PHD
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 1438
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29071
Mailing Address - Country:US
Mailing Address - Phone:803-358-9410
Mailing Address - Fax:803-358-9409
Practice Address - Street 1:123 LIBRARY HILL LN
Practice Address - Street 2:SUITE B
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3895
Practice Address - Country:US
Practice Address - Phone:803-358-9410
Practice Address - Fax:803-358-9409
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC828103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical