MEDICARE: LINDSEY PACE LCSW LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1639760366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINDSEY PACE LCSW LLC

Provider Business Mailing Address
First Line	:	3301 RICHMOND HWY # 1153
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22305-3044
Country	:	US
Telephone Number	:	757-206-2824
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 RICHMOND HWY # 1153
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22305-3044
Country	:	US
Telephone Number	:	757-206-2824
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	LINDSEY PACE
Credential	:	LCSW
Telephone Number	:	757-206-2824

Provider Enumeration Date	:	01/26/2021
Last Update Date	:	09/02/2022

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